SurgiPod – Stephanie Collins, CEO of Austin Retina Associates

Welcome everybody back to SurgiPod,  I’m very very excited to have a top-tier CEO join us today Stephanie Collins is the CEO at Austin Retina in the great state of Texas. It’s a real pleasure to have you join us today thank you very much, Stephanie. 

Thank you very much for having me I’m happy to be a part of it.

Great so firstly tell me a little bit about your own sort of personal journey to becoming CEO at Austin Retina. 

I started at Austin Retina 21 years ago. I was sent to Austin Retina as the file clerk from attempt service after my mandatory 90 days. I was hired on and I’ve actually worked in every position in the organization except for research. I took over from for the previous administrator when she retired after 23 years in 2014, and I became the CEO. 

It’s been an interesting journey. They’re a great, organization super supportive, and very encouraging. I got my undergrad and graduate degrees while I was working there more recently just in the midst of COVID, and for fun maybe or supportive of like health issues. I have also become a certified health coach and I’m looking forward to sharing that knowledge as well. 

Wow! So in the last seven years, you’ve been CEO, you’ve really covered all those different roles. How important is that to have both the clinical experience which you have and also the business and administrative experience in order to be able to really actively play the role which you play as CEO at the practice?

I do truly believe that anyone can be a leader. You don’t have to have all the background that I have to be a fantastic leader and CEO, I think anybody can do that as long as they’re open to collaborating and being a good listener and supporting, and encouraging their staff. 

I do think that it has benefited me along the way as its really nice to understand where my staff is coming from even though I may have not worked on the front line for many years I do understand the general sense of their job and what they’re talking about and so if they’re excited about implementing a new process in our organization I know what may or may not work or if they’re really frustrated about something I can relate to that I do try to get down and participate on the front lines when I can so in the midst of COVID I was helping them covid screen I would go back to checking in and checking out just so that I can kind of understand what they’re going through. So I think that gives me a little bit of a leg up to support my staff, but I don’t think it’s required to become a great CEO or great leader by any means.

You run a very tight ship at Austin Retina and are you super efficient in everything which you do and everything that you achieve. Could you describe or give us some examples of two or three different things that you feel are critical to ensure that all the operations and all the processes at the practice are run as smoothly as you would hope for them to run?

Sure, I think a lot of the success of our practice and being super efficient, really comes from the lean initiative that we did in 2015. Like any retina practice probably or any medical practice the constant worry or complaint from patients about your wait time was a big deal for us.  We’re a fantastic practice and we have great outcomes  we just need to focus on wait time and so we did this big lean initiative back in 2015 and really what we realized was that we had a huge culture shift while we were going through this lean initiative and what i mean by that is while we were able to identify efficiencies and inefficiencies and collaborate with our staff to really become a better practice to provide great care for our patients we really learn to empower the frontline staff to make those decisions right so we’re not having them do high-level business decisions about the finances or obviously medical decision making from the physicians but if it is general operational or the workflow of the practice or how we can provide a better service to our patients we empower them to come up with new ideas and trials and collaborate to get those things done so i think that that has made us just a better practice in general and to help provide better care lean was a huge deal for us and so we have a multitude of trials that are created by our staff. Sometimes they work and they don’t or they don’t work sometimes they work for one specific team so whether that’s the insurance department or the call center or maybe one clinical team maybe they become universal between the whole organization, but it doesn’t matter as long as they are creating and empowering themselves to come up with all these ideas we truly believe in a culture of failure so encouraging them to step outside their comfort zone and come up with new ideas and these trials try them out worst case scenario we go back to ground zero we evaluate why or it didn’t work and we start over right if they truly believe in the idea they can tweak it and then kind of go back out and that allows the physicians to really focus on their patients and what they’re medically trained to do. It also provides a great growth opportunity and team building for the staff on its own.

I’ve seen lots of groups try to initiate lean programs and when they communicate those messages about these types of initiatives it sometimes gets a little bit lost in translation to the staff it’s very esoteric and very conceptual. How were you able to ensure the staff understood and owned some of these initiatives?

I think in 2015 it was definitely this idea of implementing something new despite initial fears that it would require hour meetings and extra training. But once the staff really started, even within the first few weeks of them trying something simple as putting a flag up to signify that there was a room open and filling that room instead of putting them in the sub-dilating room they all of a sudden saw improvements in their workflow and the clinical side and the patients were already raving. 

They were saying I don’t know what you’re doing differently but I love it keep it up!” That built this excitement and this momentum and then the relationship between the patient and the employee right is a two-way really important connection that seemed to improve and so there’s just this general excitement in the office and i think once they got that and everybody was sharing about that they were propelled to keep going. So there was definitely that original tug of like ‘oh God you’re making me do something new right’, = but once they started getting that positive feedback they were they were sailing forward. 

For any new idea that we think about now, we begin with a trial. It’s very small baby steps just to move this forward in the right direction we don’t just jump head in or whatever feed in or whatever you want to say like we don’t just jump in,we tip our toe in and work through all of the concerns and those what-ifs. And the same goes for trials in a group or per department – we see how it goes before we deploy it throughout the organization. 

With lean and all of these things, you need goal setting and metrics to make sure that it is actually working. So questioning what is the goal of the trial what are you trying to achieve.

For example, if you’re looking at wait time for a patient what is your current wait time now and once you make the change for your trial what is the end result sometimes the result just might be subjective as in the patient felt like they had a better exam or better visit with us. Or it could objective from the staff, for example, our time wasn’t even any better but we felt a sense of relief and a sense of calm that we didn’t have before right so it doesn’t necessarily have to be numbers driven it can be subjective as well. Also providing feedback collaboration building of trust and teamwork all of those things are super important in any organization.

What does it mean to have a culture of failures as well as a culture of success? 

Success and failure go hand to hand. We want to encourage everybody to fail forward right we want you to make those small steps and do those trials to move you and the organization forward to provide a great patient experience and also a great employee experience. So we encourage them to do so with all of these small scale trials. The culture failure piece really comes in is that if the trial doesn’t work out we’re not upset about it right nobody intently harmed a patient or did something wrong we all agreed that we were going to move forward in this trial to try something out and if it doesn’t work we revert back to the old way so that if a person makes a mistake and you yell at them or reprimand them that doesn’t really work. It doesn’t support this culture of trying new things out. 

So you have to have some buy-in from that it at takes a lot of work for sure right you said that you work very closely with all of your teams and you get your hands dirty go straight into the trenches and work with the front of the staff and also I assume that I know you work very closely with the surgical scheduling staff for the practice what are some of the pet peeves or frustrations that you hear from those different teams from the surgical scheduling staff about what they do or what they have to do with coordinating surgeries which are very complex in your environment for your practice for your surgeons?

Before we started using Surgimate,  think a lot of it was just the redundancy of the work right they had to get in the chart they had to fill out this paper form by hand every aspect of the demographics and the insurance stuff and so and then even before we got with you guys we went from paper to kind of an adobe pre-filled form which made it a little nicer but it still was a manual labor and redundant work. 

We looked for innovation let’s see if there’s something out there that we can offer our staff to supplement their work and make it easy I mean we’re really busy practice things just keep getting more convoluted and harder to meet and so we stumbled upon Surgimate and it’s been fantastic so I think that a lot of the frustration before it was just redundant work and having to do a lot of things by hand and now I think that the frustrations really might just be more on the aspect technology in general and not against Surgimate, but you know –  if your internet goes down you’re like oh geez now what?!

So there’s nothing you can do about that, but they were one of the first groups for us to really set up like a work from home platform and that was kind of a new idea for us that was even before covid which was really helpful we had a couple of random people that were working from home i would have a random work from home day but the the surgery schedulers were the first people they were taking up an office space on our clinical floor and we were like we need more clinic space right to be more efficient to have more space to work out patients and we’re like we got to get you out of this building and so that was kind of one of the other drivers to find a new technology to support them to work from home so now it’s great they can log into your system it ties into our pm system it pulls everything over as far as their demographics they can save templates so they don’t have to read like create a surgery each time we can download the pdf and fax it right from their computer to the surgery center so they’re not having to deal with all this paperwork anyways it’s been it’s been really fantastic but they were the step in our first direction of getting people work from home and it’s been a really nice transition. 

Technology is helping create much better efficiencies and remove all the redundant work you also touched on something which is more around the agility and the ability to change how staff are working together, are there other roles that you see technology playing today at your practice? Given your role as CEO, do you have thoughts on where technology is going to help the practice as you move into the future?

We implemented and started with 13 new software so we are constantly looking for anything that will help support our staff because at some point you’re going to be limited by how many staff you can have in the building right by factors such as space constraints or financial constraints. So it’s not meant to replace a staff by any means it’s just meant to supplement their work and help offer a more calmer environment so we are constantly looking for new ideas. 

We use technology for all sorts of things like pre-registration for the patients, and parking to ensure patients are waiting in their cars to stop the spread of COVID in the waiting room. W used a two-way texting option to communicate with them and set up expectations we even used the same two-way texting option to reach potential new hires earlier that are interested in applying for our work instead of emailing and kind of waiting for them to sit through that, we just text them directly right so technology has come a long way. 

We had a referring provider the other day rave about the fact that she could refer a patient right through our online platform on our website so I think that moving into I guess the 21st century out of like 2015 is typically a little slow i think sometimes in healthcare but technology is fantastic and you should always use it to supplement your workers.

Sometimes I feel that healthcare is not in 2015 they’re more like in 1915 when it comes to how they’re working within certain surgical practices in certain groups! It’s almost Halloween which means it’s back to conference season summer’s basically on its way out. Conferences are a great opportunity to meet with colleagues I think now is really the first opportunity that a lot of people within the industry are getting to meet with other people how important do you feel it is to work together with your colleagues and other CEOs from either retina practice or ophthalmic practice and someone what are the sort of lessons that you’ve learned from other executives who you’ve worked with and share knowledge with?

It is so important to collaborate with people. Just in general health care if it has general management of healthcare or other sub-specialties we’re all living kind of in the same kind of craziness; for example reimbursement cuts and policy changes – and so to have those folks to lean on and collaborate with and understand maybe what are you using, how is that working for you, how has it benefited you…how did you change this policy is something that it’s just invaluable.

I have an upcoming conference coming in a week or so and it’s the first live one that I’ve been to since covid. I’m super excited to see my peers and get back together. While some of us have been doing virtual zoom meetings to keep in touch or maybe emailing back and forth which is super helpful right if you need to get a hold of somebody, it’s just not the same as seeing somebody in person, and really having that in-depth conversation and sharing new ideas. Just to hear about any new software’s they’re using or new tips and tricks they have in their office. Or take hiring, this is a big struggle at the moment, so knowing are they doing something different with how they’re finding new talent to join their group so anything those things are they’re just invaluable I encourage everybody to attend them or find a good group of other administrators whether in your field or outside your field to collaborate with. 

One of the net effects of covid has been a real struggle that I’ve seen amongst other practices in retaining good talent and hiring new talent. What are the tools that you as CEO have found most successful to find the best talent at the practice? 

We definitely have a mentality to hire for character training for skill so most of the staff that we bring on do not have any experience in ophthalmology let alone retina. So we want to make sure that we have somebody who is going to match our culture, that they want to be part of something bigger than themselves they want to give back and they really want to collaborate with a great team right so if they meet a match who we are as an organization we will train them in any hard skills that they absolutely need. That is what I got 21 years ago at the age of 18 and that’s what I believe as the CEO I think me collaborating with my executive leadership and our managing partner on what we’re doing well areas we need to improve are we having any struggles with them hiring how long is it taking to get somebody in the door we’re constantly revamping those processes to see if we can be better and then I participate in as many of the meetings as I possibly can with the team to create an internal lean certification course or a leadership development course. 

We really support the growth of our individuals throughout the organization. I will participate in that we did one last night on conflict resolution right it seems that with covid people are just generally angry and welcome desk staff and kind of the frontline staff are really kind of taking a beating right nobody wants to wear the mask anymore. And everybody’s giving them a hard time and so we were just trying to provide them extra tips and tricks or whatever on how they can kind of deal with that conflict and feel supported throughout the organization on what they could and couldn’t say so as many of those things as I can participate on I absolutely will because I really like to connect with my staff. 

In over 20 years of working at the practice I’m sure every day is a story every day you go into the practice a patient comes in that’s got this issue or one of the staff members but within all the hundreds or thousands of stories that you have has there been any particular experience that has left a lasting impression on you and change the way in which you operate or you want your staff to operate for how the practice can provide the best level of patient care?

I was a scribe for 11 years with one of our providers who did most of the pediatric retina in our practice and I think that that was super valuable to learn how to connect with people in a different way obviously i was having to connect with all of our patients on a day-to-day basis but when you’re talking about a child and their parents who might lose their eye from rare cancer or have to undergo chemotherapy at six months old or seeing a baby a neonate and then nicu right who has 80 years of vision you’re trying to save, I think that those cases were probably the most impactful for me and really trying to understand how to communicate with those families early on and offer them the support. 

My dad is a type 2 diabetic and obviously, that is a big part of our patient population and so seeing him struggle with that and not really understanding his disease in the general sense of how to care for himself and what that really means and relating that back to our patients I think that gives me a different aspect too of wanting to offer as much support not just from the retina perspective but just the education of resources for them and nutritionists or dietitians or anybody that can help them with the holistic health portion I think is really important to me as well. It’s hard to do sometimes when you’re in a really busy practice to not think about just what it is in front of you. I think our health care system is very divided right we each have our own sub-specialties and we just check off our box and move the patient along so anything that i think you can do to add and subsidize great care and experience with a patient is really important.