By Dr. Trevor Miranda. 

Dr. Miranda contributes his thoughts and perspectives on the topic of Independent Eye Care Practice in Eye Care Business Canada. Check out all of Dr. Miranda’s articles in Independent Insights category.

If you are a practice owner then you are a leader.

It is important to embrace this role, learn to excel as a leader and create future leaders in your organization. Too often the owner abdicates the leadership responsibility and, as a result, the void is often filled by dysfunctional power grabbing protectionist team members looking to control everything and limit the growth of others.

Driving the Bus
As a leader, you need to be able to lead from the front.

This component of leadership is tasked with the awesome responsibility of “being awake at the steering wheel”. This means being ready to make turns to keep the bus on the road to business prosperity, to deftly dodge the potholes (like the Pandemic) and knowing when to stop, rest and refuel.

The driver of the team understands what it takes to do each job to keep the team moving forward. Valuing each job is crucial to engaging the entire team to keep their eyes on the road so they can also catch threats that may end in disaster.

At the Back of The Bus
I remember road trips with soccer and hockey teams growing up.

Only the “cool kids” got the back seats. The cover of invincibility and greatly reduced accountability made the back of the bus the most coveted locale.

A great leader lets others drive. Encouraging and fostering leadership skills in others will incubate a culture of empowerment. Great leaders can sit at the back of the bus and enjoy the fun and reduced stress that comes with that.

These special leaders are in tune with the heartbeat of the team. Make sure you take time to have fun!

No Back Seat Driving
Great leaders let others lead.

The bus of business is on the road 24/7. You can’t be a good driver all the time. Encouraging other team members to lead perhaps by running a meeting, hiring new staff, creating training plans for each team member or investigating new product solutions are all key to fostering a Leadership Culture.

It is important to let the driver in training make decisions such as where to turn without constant direction. Don’t be a backseat driver! Emerging leaders of organizations need some room to FAIL (First Attempt in Learning). Crucial to a learning organization is that reviewing where we are and how we got there brings new insights.

All drivers in training need to know when they take a suboptimal route and understand ways to improve on a go forth basis.

Under the Bus
The concept of throwing a teammate under the bus needs to be revisited.

Taking team accountability for mistakes such as a missed order, incorrect Rx, or any other perceived patient slight allows the patient community to recognize the team care they are receiving.

As a leader, you should always be “under the bus” with the entire team. If we are attached together we cannot throw anyone under the bus without ourselves coming along for the ride.

The Wrong Bus
Sometimes passengers on your team bus may experience motion sickness or do not appreciate the direction the bus is going.

In your company analogy, these passengers are wishing they weren’t even on your bus. They want to fly first class (who wouldn’t?!). It is crucial that the leaders identify these team members and ensure they fully understand the direction of the organization and exactly what roles they are expected to undertake.

If that is unsatisfactory then stop the bus and exit this employee. Perhaps a different journey is more suitable for them and it’s time for them to find a different bus.

It’s better to be honest and frank in these conversations but remember to be kind.

Driving Standards
There are certain attributes that good leaders value including honesty, trust, hard work and kindness.

In the same way that we follow “the rules of the road,” great leaders don’t cut corners when it comes to “doing things the right way.” Crucially fostering other leaders is very important.

We have created a pathway or “journey” for each team member by overlapping training and compensation so that each employee feels some control of the direction that the team is heading.
Great execution relies on an amazing team all driving in the same direction!



Dr. Miranda is a partner in a multi-doctor, five-location practice on Vancouver Island.

He is a strong advocate for true Independent Optometry.

As a serial entrepreneur, Trevor is constantly testing different patient care and business models at his various locations. Many of these have turned out to be quite successful, to the point where many of his colleagues have adopted them into their own practices. His latest project is the Optometry Unleashed podcast.


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End of Time

By Dr. Trevor Miranda. 

Dr. Miranda will be regularly contributing his thoughts and perspectives on the topic of Independent Eye Care Practice in Eye Care Business Canada.

Time may be our most precious resource. Time has a finite and infinite horizon depending on the reference point. We all know and understand the saying “time flies when you’re having fun!” When you can’t wait until the end of the day rolls around, time seems to go slow, punishing you for watching it, agonizingly; seemingly consciously slowing the seconds down.

When it comes to time at work, most of us spend half our waking day “making a living”. It is estimated most people spend one third of their life at work.

There are those that dread these work hours. They work to have time off. They don’t enjoy work and their time at work brings them stress, anxiety and lack of fulfillment.

Then there are those of us that enjoy working. We choose an attitude and a mindset by embracing the day at work with excitement and anticipation. In this way, work is not so much about time as it is about the individual interactions and experiences that every day brings.

Slow Down Doc!
In my early career as an optometrist, I would fret about being late for my next patient. I was worried about the emergency “fit -in” that would distract my mind from the patient right in front of me.

One patient told me to slow down. It made me realize I was doing it all wrong. I still really like running on time but now I give 100% attention to my current patient.

I started using a chair-side assistant that scribes my notes so I can give full time eye contact to my patient, engaging with them on a deeper level. Rather than having to turn my side to them and type notes (I use the hunt and peck typing method), I can now pick up general body language and nuances to ensure my patient understands and can comfortably ask all their clarification questions.

I won’t leave until all questions are answered. I use videos to send information about disease conditions and invite follow-up dialogue if required. I page my optical experts to be present in my exam lane to enable a seamless hand off resulting in increased confidence in my recommendations that are reviewed by the opticians. This in-lane hand off produces greater optical capture rates and improved compliance to treatment plans.

Saving Time
Being time efficient or “lean” is something that can pay off both financially and in providing more time for other options. I calculated that saving two minutes per patient would equate to 16 days of time off or extra patient slots (based on 16 full exams over 48 weeks).

This can be done by delegating contact lens trials, utilizing a scribe, in lane handoffs, using multiple exam rooms, having scans and phoropter prepared for the patient in advance and many other ways to improve patient flow and efficiency.

Once you have saved the time you can decide if you want to use it to buy more time off or to see more patients.

So next time you are thinking why is the day dragging on, change your perspective and enjoy and be thankful for every minute of your day!

Quality Versus Quantity
It is not the amount of time that you spend with the patient that matters; it is the quality of that time.

Important to ensure you maintain as much eye contact as possible while the patient is speaking. It is challenging to look away and make notes and still have that patient know you are listening.

Delegate data gathering to techs and use the doctor’s time to listen, recommend and customize solutions for your unique patient.

Creating an amazing experience requires the team to be able to flex around each individual patient’s needs. I don’t like to see patients “waiting”.

I would rather the patient’s perception be of a new experience. Techs let the patient know that the exam is starting with some testing before they see the doctor. Perceived wait times are minimized by “pre-shopping” for glasses and education via videos on conditions and solutions which are chosen based on the patient’s profile.

The Acceleration of Time
As we get more mature in our work lives and the years pass by, we often lament that the years are going quickly.

This usually comes with the realization that time is precious and we don’t have an infinite amount of time left on this earth.

I find myself full of gratitude for each day; it’s a blessing to have the privilege to go to work, walk the dog and learn new things.

After 27 years as an optometrist, I am hoping for 27 more but thankful for each one!



Dr. Miranda is a partner in a multi-doctor, five-location practice on Vancouver Island.

He is a strong advocate for true Independent Optometry.

As a serial entrepreneur, Trevor is constantly testing different patient care and business models at his various locations. Many of these have turned out to be quite successful, to the point where many of his colleagues have adopted them into their own practices. His latest project is the Optometry Unleashed podcast.


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The cornerstone of a superior, profitable practice is the productivity of a staff that is focused on patients and practice issues each work day. I am a part-time associate in a two-doctor, four-employee practice, We Are Eyes, in Boca Raton, Fla., and our practice works hard to keep our employees productive and focused on patient care.

Here are key ways to boost productivity, and some of the distractions that could damage productivity–and what to do to emphasize the positive use of tools like smartphones and tablets, while decreasing the chances of these things becoming distractions.


Electronic health records are designed and intended to make a practice more productive, but most doctors find themselves less productive at first. Practices that transition from paper to EHR find that it changes the way employees communicate with each other.

Doctors find themselves spending more time entering data and less time with patients at the beginning. And if they choose to delegate the data entry to an employee, again, that is less time that the employee has to do other tasks.

But once the transition period is over, and the practice has worked out all the initial EHR kinks, a good system can make the doctor and support staff more productive. An EHR system can allow for patient data to be shared more easily between multiple physicians and between physician and support staff.

An EHR can also eliminate medical errors that occur from poor physician handwriting. The days of the optician filling a spectacle prescription with -3.25 when it should have been a -3.75 are less common with EHR.


I believe that the best way to enhance productivity is with teamwork. One team member cannot be successful without the help of everyone else. And no team member fails alone either. For example, if an optician has a really big sale, but the insurance was not billed properly, and the patient was not notified that the glasses were ready in a timely manner, the patient is likely to be upset and not return. But if everyone does their part, the success is shared and everyone benefits, not just the optician.


Holding regular staff meetings are critical for overall productivity. But just like anything else, many employees will consider too many meetings a waste of time. The key is to have meetings with a clear goal and keep employees engaged. Sometimes my employees get tired of hearing me say the same things over and over again. So, I often allow someone else to run the staff meeting.

For example, give a technician the opportunity to educate the entire staff about the features and benefits of a diagnostic technology. Let the technician research glaucoma and the importance of visual fields testing and OCT. Have them work with insurance billers and understand the appropriate coding involved. Allow them to present the case of a patient who is being treated, and how it affects their lives. The goal is to have the entire staff take pride and personal responsibility for the work they do. They will be more productive as a team if they know it is making a difference in a patient’s life.


The most common challenges to staff productivity are socializing with co-workers, online activities, texting, personal phone calls and social media. When employees waste time, it also looks unprofessional to patients. If left unchecked, the poor habits of a single employee can eventually spread to other employees. Before you know it, you have a problem with office morale, high employee turnover and major headaches for management. If managers are constantly forced to babysit employees, they can become overwhelmed and less productive themselves.

Before solutions to productivity killers can be established, it is important to understand why employees are wasting time. According to’s Wasting Time at Work Survey, 35 percent of employees waste time because they don’t feel challenged. Other reasons for wasting time are lack of incentive to work harder, lack of job satisfaction and just being bored with work.


A key solution to productivity killers is starting with good habits from day one. When a new employee is hired, they should have a crystal clear understanding of their office policies and their manager’s expectations. And a new employee should understand on day one what the consequences of poor behavior are. In addition to understanding what their job description is, a new employee should also know how they affect the entire team. When an employee knows that they are part of a team and that their performance affects the entire office, it is easier for them to see the value in what they are doing and feel a sense of purpose.

But what does an employer do with that long-time employee who won’t stop texting? Or the employee who clocks in on time and spends 20 minutes drinking coffee and socializing? The key here lies in the manager. Managers need to lead by example. If a manager is constantly socializing and doing personal activities themselves, there is no hope of controlling the rest of the staff. Then, it is critical to set, communicate and remind employees of expectations. If your staff knows that their performance is valued, being measured consistently, and that there are specific consequences, they are more likely to be constructive and less likely to waste time.


Smartphones at work can hurt your practice with wasted time–or be used as tools to improve the patient experience.

It seems like everyone is addicted to their cell phones. And when a practice owner or manager sees productivity being killed by smartphones, the knee jerk response is to confiscate everyone’s phones. Lock them up in a drawer. Forbid employees from checking their phones while they are on the clock. Inevitably, the argument will come from the employee who needs their phone to communicate with family members in the event of an emergency. Many employees may feel more anxious and distracted if they feel unconnected. How does an employer balance and respect an employee’s private life with their work life?

An optician in Dr. Nguyen’s office checks his smartphone while working on a patient order. Dr. Nguyen says mobile devices like smartphones can be distractions, or they can help staff better serve patients, providing an easy way to look up information or additional products to order.

Each office has to establish their individual policy. Each practice owner has to be comfortable with their own decision. And whatever a practice owner decides to do, chances are, they will make some employees upset. But if you create a policy in writing, make it plainly known to all employees. Make the consequences known clearly as well. If you choose to be hard line and lock up all personal devices during work hours, then be consistent with all employees, no exceptions. But then consider allowing an employee to give family members the ability to call them on a landline in the event of an emergency.

Personally, I use my smartphone to look up information, market the office and communicate with patients regularly. It would be impossible to ban smartphone use in my office. But I have a strict rule that employees cannot have their cell phones out while they are with patients. Devices need to be in their pocket or in the desk drawer, not on the top of the desk where patients can see them. When patients are in the office, taking care of them is the priority. I know I cannot watch all the employees every minute of the day. I believe in the honor system, and I believe in strict consequences if they are caught with their phones out when they are with a patient.


Even with all your efforts, there may be that one employee who cannot go more than a few minutes without checking their phone. There is always that one employee who distracts others with stories about their evening plans or their kids. These are the employees who make great advertisers and marketers for your office. These employees know more about social media than practice owners typically do. This is an opportunity to turn productivity killers into productivity helpers. If you have an employee who is an expert at Facebook, Instagram, Twitter, SnapChat and Pintrest, make them your social media guru. Give them a set amount of time each day to use their social media skills to market your office. Be sure to set specific limits and check on their productivity.


If you don’t already have your internet filtered for employee workstations, go immediately to your server and block specific web sites. There is no reason an employee should be able to access dating and unsavory web sites at the office. Blocking other social media sites from workstations may sound extreme, but it can eliminate problems before they start. The only caveat is to be sure not to block any social media networks, like Facebook, related to the marketing work your employees do.


Another source of wasting time is personal conversations between staff and patient. We all want our patients to feel at home in our office, and to feel that we know them on a personal level, but a conversation that goes too long will affect productivity, especially if other patients are waiting. Employees should be trained to be friendly and attentive, but to know when to politely end a conversation with a patient.

For example, if an optician is extremely detail-oriented and takes pride in the fact that they really get to know the patient, patients will love them and request their services regularly. But if each simple encounter takes over an hour, take that optician aside and let them know how valuable they are, and how you and your patients appreciate the job they do. But make it a goal to politely finish a conversation and move on so other patients don’t have to wait.


Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometry and works part time as an associate at We Are Eyes in Boca Raton, Fla. To contact her:


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