Welcome And Scaling Without Losing Care

Dr Andrew Greenland 0:00

So welcome back to Bridges and Health Amendment. This is the program where we speak with leaders of private and patient-facing healthcare, about the realities of building, running, and growing modern healthcare organizations. Today I'm joined by Ed Yee, general manager of creative valley categories leader in British Columbia, and works on the operational side of a multi-location optimology organization. And I was particularly interested in having them on because there's a side of healthcare growth, the patient value fee. Opening or growing locations is one thing. Making sure the people that posted to the systems and patient experience can grow with the organization is something else entirely. And that's particularly relevant because when we first connected, he identified growth and scale as one of the biggest operational challenges facing the organization. So with that, Ed, I'd like to welcome you to the show. Thank you very much indeed for joining me today.

Ed Yee 0:48

Yeah, thank you, Andrew. Thanks for having me. Appreciate it.

Dr Andrew Greenland 0:51

So let's kind of start at the beginning. How did you get into this world and what eventually brought you to Fraser Valley Cataract and Laser?

Ed Yee 0:59

Well, that's it's an interesting question. So just by way of context and background, I'm not an ophthalmologist and I don't have uh a career path that started in this area. Um my career path was actually in more originally more into consumer package kids and cosmetics. And then over the course of my career, um, I was recruited into um other senior executive roles that were in healthcare. And that that segue into healthcare actually led me into Fraser Valley Cataract and Laser about two years ago. So I had an opportunity to join the organization. Uh, they were looking for a person who had senior leadership experience, who maybe didn't necessarily come from the um the business of ophthalmology,

Eddie’s Route Into Healthcare Leadership

Ed Yee 1:50

but who had the appropriate experience in business and healthcare. So that's how I ended up with the organization.

Dr Andrew Greenland 1:58

Thank you. And tell us a little bit about your role now and how it fits into the bigger picture of Fraser Valley.

Ed Yee 2:05

Sure, yeah. So I I'm the general manager of the organization, and uh I essentially run the business operations for the ownership group. So our ownership group, uh, they have a very busy clinical and surgical practice. And I'm sure that the people who are watching this podcast can attest to the fact that trying to operate a um thriving clinical and surgical practice while trying to run the business operations can be very challenging. And especially in our organization, which uh has multi-sites and a lot of moving parts. And so, what I do is I essentially I run the business operations on behalf of the ownership group. So that includes uh the clinical operations, uh, the marketing, the physician relations, the HR, all those things that go into running a vibrant organization.

Dr Andrew Greenland 3:00

Thank you. Now you've obviously come from a different space, and I'm just wondering how your role has evolved as the organization has grown. How did it sort of start and how is it looking now compared to you know when you started in there?

Ed Yee 3:12

Yeah. Certainly, my role has evolved as the organization has evolved. So we're we're in a uh an expansion phase right now. We have intentions of growing the organization beyond what we are right now. So when I joined the organization coming up on two years ago, um, it was really oriented around running uh a lot of the day-to-day operations of the business. But as we move and evolve into this new phase where we do want to expand our organization, uh, my role is evolving into more of a strategic role that's going to be required to, I think, um, help champion and lead the organization through this really exciting next phase. And so that's how I see uh my role evolving right now. Not to say that I still won't have some involvement on what I call the day-to-day, but um there's also going to be some time and um investment and

Inside A Multi-Site GM Role

Ed Yee 4:20

and effort required to strategically move this organization forward.

Dr Andrew Greenland 4:26

Thank you. So you're clearly wearing lots of hats. Um, you seem to be doing the work of a number of different departments. What does a typical day actually look like for you? And I I know this probably is no such thing as a typical day, but how does it there is no typical day, you're right.

Ed Yee 4:42

Um, a typical day for myself would be um really around working with the the leadership group and the organization to help uh guide, steer, prioritize when it comes to our clinical operations uh and our what I call our outreach and business development efforts. That's probably where I'm spending most of my time right now. So on the clinical operation side, uh what we are trying to do is we are trying to make sure that we have a really good patient experience for the people who come into each of our four sites, and so there's a lot of effort around trying to fine-tune things like uh patient schedules, um, full workflow, uh patient flow, um, and on the marketing business development side, we have um quite a bit of effort when it comes to trying to market the business to consumers. And then also as we try to build out our our referrals from optometrists and uh GPs, we have quite a bit of effort going on to build those relationships as well. So um, those are probably the two main areas. Uh we're beginning to focus more and more on um the people and culture side of the organization now. Um so that's really around trying to build the right culture, the right motivation, ensuring that we have the proper HR and people and culture systems in place as well, so that we are we are well positioned for future growth as an organization.

Why Private Pay Supports The Model

Dr Andrew Greenland 6:21

Got it, thank you. So I think when we talked before, you mentioned that your biggest up um biggest challenge was growth and scale. What's actually behind that? What is the challenge in doing that?

Ed Yee 6:32

That that you yeah. So um just um by way of by way of setting the stage here, as an organization, we are what we would consider ourselves a full service ophthalmology organizations. What that means is um we offer the opportunity for patients to come in for their ophthalmology eye care needs that are covered by the government, so um publicly funded, publicly funded ophthalmology um services and a clinical practice. And we also have a um a private pay component of our organization. So there are some there are some options that the government would not pay for, for example, when it comes to uh vision correction or or surgical procedures, but there are some premium offerings that a patient can have to improve their vision, and they can pay for those if they so choose. So we offer both, and you know the the challenge, the challenge for an organization like myself is that uh as I think as anybody knows, the the cost of running an organization like this can be substantial. Um the the growth in the growth in revenue that we would get from um publicly funded uh procedures and services is limited. And the growth the growth in that does not actually cover the the cost of running the organization. And so um, so there's a bit of a financial reality for us that requires us to begin to um ensure that we have a thriving private practice as well, a thriving private pay practice. So there's so so part of it is that opportunity. The other opportunity that we have, I think, is really just around ensuring that we provide our patients with the very best options that are available for their eye care needs, because um there are some really great options that um our our physicians and surgeons can offer that can really, I think, be life changers for people who have eye care needs. And so, as part of that patient care, that that patient service, we want to be able to be in a position to offer those as well. So it's both a financial reality, but also I think the opportunity just to play a part in the overall healthcare needs of our patients.

Dr Andrew Greenland 9:11

Thank you. So those are the two really important points. But is there anything that's become significantly more complicated as the organization has grown in size?

Ed Yee 9:21

Yes. Um as the organization uh grows in size, as you add, as you add more, as you add more procedures, more services, and as you add people, the the complexity naturally increases, anyways. So we're we have four sites and we have almost 60 employees. And so as we continue to build out the organization, I would anticipate that the number of sites will grow and the number of people will grow. And so with that becomes um this issue of how do you actually manage that growth and you manage that complexity. And so the way I look at it is um the organization is moving from being more of a um a smaller operator into a medium-sized organization, and with with that comes a requirement to ensure that we have the proper processes, um, the proper focus on customer care and um and um serving our patient needs, while also ensuring that our employees have a really good employee experience and can grow within the organization. So um that's where I see the the complexities being built in. Just the more you add, just the bigger it becomes and the more difficult it becomes to keep everybody going in the same direction.

Distributed Leadership As Complexity Grows

Dr Andrew Greenland 10:55

Thank you. And a similar question in your kind of growth so far, have there been things that used to work really well when you were smaller that simply don't work at the current size?

Ed Yee 11:05

Yes. I would say the probably the biggest area of um evolution that needs to occur and is still occurring even in our organization now, is really around decision making and leadership, leadership structure. So in earlier years, when the organization was a smaller-sized organization, um it was easier to manage the organization. But now, as the organization is becoming is becoming more of a multi-site organization with a larger number of employees, the leadership of the organization has to evolve to become less about one or two people that are making all the decisions and moving towards more of what I call a distributed leadership model. And what that means is uh as we as we become bigger and more complex, it's really about ensuring that the leaders that we have in our clinics um have the proper training and the proper authority to really make a lot of the decisions on their own. So it's a this distributed leadership model is a model that we're we're pivoting to. Uh, we believe it's the right thing to do for the organization. And it actually reduces risk in the organization because if you have many or most decisions, maybe just one or two people, if those one or two people are away or sick for whatever reason, it does put actually some operational risk. So it's uh there's a lot of different reasons for us wanting to move to this as part of uh the changes that we need to uh put into place.

Fixing Patient Flow And Waits

Dr Andrew Greenland 12:58

Thank you. At the moment, where would you say the biggest operational bottleneck is, if there is one for you?

Ed Yee 13:04

Yeah, the the biggest bottleneck right now for us is actually within our our clinics. So we're a really high volume clinic when it comes to our um our clinical operations, and so what we're finding is that we have uh a lot of patients, so there's very high demand, and um the the biggest bottleneck is trying to make sure that we can um have a good patient experience so that they're in and out of our clinics in a reasonable amount of time. So I think like many practices, we run into situations and days where um, as much as we'd like to have patients through the process and seeing our ophthalmologists within an hour, sometimes that's not realistic. Things happen, and so um that's probably the biggest bottleneck that we see is really at that end, and um you know, with that being said, internally in the organization, there is a lot of focus on seeing how we can try to um improve our processes to um to ensure that we try to have our patients um through in a reasonable amount of time and respect the time that they they give us when they come into our clinics.

Dr Andrew Greenland 14:24

That's really interesting. And what's the what's the impact of that on your staff? Because obviously they're the ones that are delivering this day-to-day. How does it impact on them having that high volume?

Ed Yee 14:34

It's really stressful on the staff. Um, it it's really it's really stressful because when you're in this high volume scenario, the best way I can describe it would be like driving a car at 150 miles an hour. You know, when you're driving it, when you when you're when you're pushing it uh and you're trying to um have many patients go through the clinic to serve them, when you're going 150 miles an hour, you make a wrong move, or something goes wrong, and you know, things things happen, consequences happen. And so in our case, you know, we have this high volume of patients. If something, if something happens with a patient or a few patients where they just take longer than expected, it does have consequences um for the other patients that are behind them. And so those are always the juggling acts. And I believe, like many other practices, the the the frontline MOAs and the technicians, they they hear about it most of all. So uh that can be a pretty challenging work environment at times for uh the staff that we have.

Dr Andrew Greenland 15:47

Obviously, you um have a managerial role in the business. What are the kind of things that kind of keep you up at night? I mean, is it some of the things we've talked about or are there other things which uh you know uh bother you when you leave at whatever time you leave in the evening and um go to sleep at night?

Ed Yee 16:05

I think what keeps me keeps what keeps me awake at night is um how to how to how to simultaneously balance the um the what I call the the here and now. So how do we ensure that we're in a in the day-to-day business operations running a really tight, efficient business while also um trying to simultaneously look at the uh the building out of the organization and what are the different pieces that we still need to try to put in place to uh build out um a team that can support the type of growth that we want to uh try to get in the future. And so um it's not easy trying to focus on the the execution of the operational here and now while also giving yourself enough mental capacity to think about the uh strategic. And so you know the way I look at it, Andrew, is that 60 minutes is 60 minutes, and then the the time can be apportioned into the day-to-day, the clinic operations, or the longer-term view, and so the struggle is um how do you actually balance the two so that both get equal attention? Because you don't want to over-pivot one way or the other. Um, that can have unintended consequences for the organization either way.

Dr Andrew Greenland 17:44

Thank

Keeping Culture Patient Service Consistent

Dr Andrew Greenland 17:45

you. You talked a lot about leadership and some of the challenges of running the leadership in a large organization. How do you keep your teams aligned across the different locations? Giving bigger and bigger and bigger, clearly you can only be in one place at one time. Um, how do you get everybody on board when they're working in different places?

Ed Yee 18:03

The I think the key for us is uh a few things. One is around our mission and our values, and so it's what we want to be able to do is we want to try to always um ensure that our team is aligned in the end around the you know those mission and values that we are trying to aspire to. That's so that's that's the first part of it. Um the more practical day-to-day is that what we we want to do and what we need to do is ensure that we have um many opportunities for communication with our leadership teams and also our our frontline teams. So that could be a combination of um of team meetings, it can be a combination of uh communication by written form, like an email, but it's it it's really around um ensuring that there the the communication flows up and down in the uh the organization. And um what we try to do is we try to make sure that um although we are uh a complex organization and we're growing, we try to we try to ensure that there's accessibility of the leadership to our frontline teams and that there's real transparency to uh what's going on in within um the walls of the uh the clinics and the patients. And so we think that through this process of communication, um just ensuring that we we talk about our uh our values and our principles, that can that can align us uh internally, it can align us when it comes to the recruitment and retention of employees. So it all tries to come together that way. Um but admittedly it you know it can be a bit of a juggling act at times, there's no doubt about that.

Dr Andrew Greenland 20:00

Now I'm guessing the patient experience is absolutely massive in an organization, particularly in the competitive market, and you're doing a lot of private work. How do you guys sort of maintain a really high standard of patient experience?

Ed Yee 20:13

Yeah. So we we pay really close attention to the reviews that patients um leave us. So through Google reviews, we get a lot of feedback on uh what patients are experiencing, what they're feeling when they're in our clinics. So that's one way of just ensuring that that patient experience part is really uh first and foremost. Um, we also what we also do is we do uh quite a bit of uh emphasis when it comes to the customer service uh training and the customer service oversight. So uh we've even done things in in the past, like we've brought in um an external organization that essentially has done an audit of our um our patient experience, and um they've provided us feedback on what we're doing really well from the patient experience and customer service perspective, what we can do better. I think that's really useful and it's proven really valuable for our organization. Um and it's also just when we have our team meetings, we do try to carve out some time to talk about um the good experiences that our patients are seeing. But if there is any feedback that we need to hear that perhaps isn't so positive, we provide that opportunity and that platform to hear those out. During our leadership meetings, uh, we do spend time talking about any uh negative situations that have occurred for patients, and we talk through how might we Remedy these and action them to improve as well. So patient experience remains a pretty active area for us. And we're not perfect, but uh I feel like we're we're always trying to improve and we always have that in our mindset. Uh so it's a very important part of what we do.

Dr Andrew Greenland 22:22

Thank you. And obviously, every patient feedback thing is going to be different. Are there any sort of common themes in terms of either areas of friction or things that you know you guys really excel in and people the patients recognize it and feed it back?

Ed Yee 22:34

Yeah. Friction. If we have an area of friction or feedback for us to be aware of, it's usually around wait times with patients. And again, it's a function of the volume that uh we have. So that's an area that uh I think I don't think that'll ever change. I think we always have to be really mindful of that that particular particular friction and that feedback we get from people. Um, as for the you know, the things that we really uh are happy with and excel in, um, we are within our market, we are one of the few organizations that have a what I call a full service, um full range of services under one roof. And we have surgeons that are particularly skilled in uh surgeries, and we also have a private surgical facility, which is not something that all practices have, and so it's a it's a great service that we can offer to our patients because um it can reduce the time that the patient would have to wait to receive a surgical procedure. So um again, this all goes back to ensuring that from an eye care perspective, we're serving the needs of our patients in a way that is uh efficient, respectful of who they are, and uh is customer focused as well.

Dr Andrew Greenland 24:13

Thank you. So, as a

Metrics That Signal Trouble Early

Dr Andrew Greenland 24:15

general manager, you probably need visibility across lots of moving parts and you wear lots of hats yourself. What are the metrics that you're particularly interested in in your role in terms of getting some sense of how the business is actually doing?

Ed Yee 24:27

Sure. So there's a lot of different uh business metrics that we we focus on. We actually have we used we actually have quite a few metrics and we used to we used to try to follow them, um, but what we realize is we need to pare them down to a certain number that we think really move the needle. So from a business perspective, there's the I think the typical ones like revenues, expenses, and margins. Uh one metric that we are paying really close attention to on the um the business development side is really around conversions. And conversions would be we would define conversions as the uh the percentage of patients who um either end up um end up paying privately for the premium cataract lens options that we have, or the and or it could also be the percentage of patients who we meet who are interested in in a refractive vision uh uh vision correction procedure and who end up um booking an appointment and going through the surgery. So that conversion piece is a really important one. Um we have some other we have we have some other marketing metrics that we uh we look at and it's really around um things like the so when we advertise things like um the the cost per the cost per lead are very important metrics and um um things like the appointment booking rates are very important so um those are some market metrics that we look at. We look at some other HR metrics as well, um, around uh uh tenure of employees, turnover, etc., which are probably pretty consistent with other practices as well. Um but like I said, we used to have a lot, like a huge number of metrics, and we we've typed it up now so that we just look at the key ones that really I think impact the business.

Dr Andrew Greenland 26:37

Thank you. And so thinking about the dashboard that you developed, what would you say is your earliest warning sign that something isn't working operationally?

Ed Yee 26:45

Yeah. What I would what I what we try to do is we try to look forward um each quarter. So on a on a three-month basis, we try to look forward to um a few things. One would be around the number of new referrals, so new patient referrals that we're getting um from optometrists. We look at the so when we look at our the appointments that we have in the next three months, we look at the percentage that are being filled as we move through time, and then we look at um when it comes to our our private surgical practice, we look at uh again the the percentage of available appointments that have been filled as we go through. And so if we see that um those metrics are lagging, that's usually an indicator that um we have to put some appropriate actions into place to try to ensure that that those appointments are filled. And so we we try to look uh we try to look for sure three every three months out, and um that's how we look at our business.

Technology Shifts Hiring And AI

Dr Andrew Greenland 28:05

Thank you. So thinking a little bit wider now, um, what major shifts are you seeing in ophthalmology and private healthcare right now that you're kind of this kind of influencing the way you're thinking about the future of your organization?

Ed Yee 28:18

Yeah, there's a lot of there's a lot of exciting new technology that um is available for patients who want uh to improve their their eye health and uh correct their vision. And there's options that didn't didn't exist uh even a few years ago. And so you know what excites us, uh but also we'll get to be mindful of is that we we see an opportunity to really be a preeminent health, I eye health care partner with our patients, and so you know, as we begin to uh as we begin to look forward, uh I think our challenge as an organization is um how do we actually uh communicate this to the general public so that they're aware of the options that they have to improve their their eye their eye health. And how do we how do we do it in a way that is also uh cost effective for the patients and really adds value to them as individuals? And so we we are really excited about the opportunities. Uh now it's really around how do we just ensure that people know about what we have. Um how do we educate them in a way that is not too technical and too clinical, and in a way that they can really understand? Um, I'm sure you can appreciate that um medicine can be very technical and can be you know a little scary for some people. So that's our challenge as an organization is to uh to really try to accomplish all the things I've just talked about.

Dr Andrew Greenland 30:09

And are you seeing any kind of trends in terms of the expectations of your patients or your clients?

Ed Yee 30:17

I don't think that we're seeing any changes in terms of the expectations. You know, the the bottom line is they do want to see their uh their eye health care needs met, they want to see their vision improved, where it can be improved. I think where I think where we're seeing some uh some changes is um two things. One is uh what I alluded to earlier, and that's around ensuring that we can see patients in a in a time-efficient manner because people are really busy, and uh they they don't necessarily have the willingness or the desire to uh wait unnecessarily to see our physicians, and so that's something that I think is um perhaps maybe it's always been there, but it's becoming more prevalent now. I think the other um change in needs that we're seeing is much like society in general, how how people are getting information is changing and needs to change. So while we do have patients who still want to see a paper-based brochure and paper-based information more and more, um, the the people that we're seeing coming in, they want to be able to um see things online, they want to be able to book their appointments online instead of phoning into our offices and booking the appointments. So we are seeing um that sort of shift in um the patient behavior and the patient needs as well. So I probably say those are probably the two things that we're seeing evolving, Andrew. Thank you.

Dr Andrew Greenland 32:06

And um, you have a large team. Um, are you finding anything difficult or more challenging about um recruiting and retaining staff as you've been in the organization?

Ed Yee 32:16

We are, we are so um we have found we have found in recent years that when we're uh recruiting team members, um it's it's been more it's been more challenging to find people with the what I what I think would be the right customer service orientation because we have our own internal training, so you don't necessarily have to have an ophthalmology background if you're to join our our our team as a technician or an MOA. We we can work with we can work with people on those technical elements, but it's really around what we're finding is um having people who we feel have the right um the right patient centricity or that right customer service orientation, and so uh we want to be discerning like every other employer when it comes to areas like this, especially given that our employees, many of our employees are fret-facing with the patient. So this is really a really important point, and so we we we have been challenged. I won't won't sit here and say that we haven't been. Um but in understanding that uh we are choosing as well to invest in not only the technical side of training, but we want to make sure that we do invest time in the uh the customer service training, and just as importantly, try to provide some ongoing feedback to our uh our team members when their customer service is recognized and when there's also opportunities for improvements as well.

Dr Andrew Greenland 34:07

Now, I can't um not ask you about AI because it's a bit massive topic. I just wondered how you or the organization have embraced AI if at all and what it's been most useful for for you guys.

Ed Yee 34:20

Sure. So AI is AAI is a very vibrant topic in our organization right now. So far, it hasn't been used at all in either the clinical or surgical practice. Um I'll I'll be very curious as to how AI eventually embeds itself into the clinical and surgical side of the organization. We we've been using AI more around um speeding up the process of doing things like revising job descriptions in um building out our marketing strategy and suggesting, you know, so we we will input into AI the various things that we're we're trying to achieve when it comes to say marketing or physician relations, and the the output will be um some some draft documentation that we can review and um we can decide if it if the ideas and the thoughts and the strategies are useful um or if we need to massage those. And so um what we have found is that um AI really speeds up the pace at which we can um implement and think through what I've just described, so um it can it can pull together thoughts and ideas literally in minutes that our team would probably have taken days or weeks to have done. And so that's to us is the real advantage of of AI. And uh I think we'll continue to use AI in the organization in a in a bigger way in when it comes to um business development, marketing, communications. Uh and like I said, I think that it'll be exciting to see how it takes shape in the clinical and surgical areas.

Dr Andrew Greenland 36:16

Thank you. I'm gonna ask you a completely unrealistic thing. If I was to give you a magic wand and you could fix one problem permanently in the business tomorrow, what would you choose?

Ed Yee 36:30

If I could fix one thing, I think it would be really around could we develop a foolproof, seamless way of ensuring that our patients, from the time that they check in to the time they've completed seeing our physician, can flow through without any hitches at all, and um they can they can go through flawlessly. That would be my ultimate magic wand opportunity, Andrew. Thank you.

Dr Andrew Greenland 37:05

Um it would require probably magic to do that, but I think that's a good question to ask. Finally, where would you like to take Traser Valley, Cataract, and laser over the next six to twelve months with your kind of visions for the immediate future?

Six Month Plan Marketing Referrals

Ed Yee 37:17

Yeah, yes. Over the next six to twelve months, um, what we want to be able to do is to uh continue really prioritizing the um the capability to serve a high number of patients in the the private surgical area for the reasons I've just described, um, around the the different options, uh the pay the patient care, the patient focus. So over the next six to twelve months, what we want to be able to do is we want to be able to um market our our our various surgical options in a much more progressive manner with better education. We want to be able to promote more frequently. So that's a that's a real priority for us to uh to do that. What we also want to do in the next six to twelve months is to uh continue evolving our physician relations because um it is our optometrists and our GPs who provide the referrals to our clinical practice, and so uh we have a renewed focus on the physician relations component as well. So um uh that these two things combined are really I think central to um our efforts in the next half year to full year. And um I'm confident I'm confident we'll get where we want to get to. Not saying that it won't be without hiccups because I'm sure there will be, but I'm if I take a bit of a look forward, I'm really confident that we can accomplish what we want to do.

Closing Thanks And Key Takeaways

Dr Andrew Greenland 38:58

With that, I'd love to thank you so much for joining me today and being so open about the realities of running and scaling the organization. I think there's some really useful lessons in here for other clinic owners and healthcare operators trying to grow without losing the standards and patient experience that made them successful in the first place. So thank you once again. It's been an absolute pleasure to talk with you this evening.

Ed Yee 39:18

Thank you, Andrew.