The Project of Vision: A New Winning PhilosophyCHAPTER 1

We refer to our center (the Istituto Laser Microchirurgia Oculare, Figure 1.1) as a “vision institute”: Refractive surgery represents its core business, but there are many other professionals involved who make their contribution to offer an excellent service from multidisciplinary perspectives in the vision field.

A vision institute is a health center entirely devoted to vision in all its aspects. All types of visual defect are treated by means of refractive surgery, employing a wide range of technology and a multidisciplinary medical and non-medical team.

In addition, ophthalmological diseases are treated in accordance with the latest protocols. In this way, the ophthalmic patient is followed in each phase of his/her life, and can take the institute as a point of reference for ophthalmic health throughout life. Let us consider for example, a patient, 35 years old, with −15D sph., −2D cyl. in both eyes.

His myopia can be resolved by implanting a phakic IOL, and the astigmatism can be subsequently dealt with by means of LASIK or ASA.

When he turns 60, he might develop a cataract: The phakic IOL can be removed at this point and substituted with an artificial lens through phacoemulsification. Presbyopia could be solved by the use of an accommodative IOL, or through corneal surgery (CK or PresbyLASIK) subsequent to lens implantation. If the patient presents any kind of problem with the health of his eyes (retina, glaucoma, etc.), the vision institute offers him a state-of-the-art center at the forefront of research where he can be confident of receiving treatment from specialists who are continually updating their expertise.

Furthermore, the patient will be followed each step of the way by the psychologist who will monitor his/her emotional situation throughout, and will provide help in facing up to the changes that refractive surgery or a medical therapy may provoke not only without, but also within.

Thus it is that vision in all its multifaceted meanings is to be considered the true core business of the institute, above and beyond “mere” refractive surgery or ophthalmology.

The main aim of the assistants in ophthalmology is to clarify all the possible doubts that can arise for patients concerning their visual situation, analyzing it through the most innovative technologies. Furthermore, we believe that it is of primary importance to establish a relationship based on reliance with the patient, to make him feel at ease in each moment of his/her transit through the institute.

In conclusion, professionalism should always be accompanied by strong interpersonal skills, and for this reason we firmly believe non-medical staff members should be fully trained in this area, stimulating the sense of belonging to a team united in the same purpose.

As soon as the patient enters the Institute he evaluates the setting, the courtesy of the staff, and their willingness to help. He also immediately realizes who it is that he can refer to, as the Front Desk and Patient Care staff wear a uniform this providing a constant and unmistakable point of reference for the patient.

It may sound trivial but the a uniform is an essential aspect of those staff members who are the first to come into direct contact with the patient (such as Front Desk and Patient Care staff).

The Front Desk staff must help the patient to feel comfortable and at ease, always welcoming him with a smile and remembering his name, offering a seat, a refreshing drink, and a choice of magazines (Figure 1.3).

On the occasion of the first examination at the Institute, for example, the patient is invited to answer some questions relating to his personal details with the help of the Front Desk staff, whose duty is also to administer a questionnaire called the Questionnaire of symptoms” edited in collaboration with the Center for Functional Nutrition for Longevity.6

The answers to the questionnaire allow the surgeon to gain a better understanding of the relationship between the visual condition of the patient and his general state of health and to provide more appropriate and customized instructions.

The Front Desk staff is personally involved in the internal organization of the Institute: It has to schedule the agendas in an optimum way, striving to reduce waiting times during agenda management, daily consultations and surgery. Only this way we can obtain efficient team work that enables the best results to be achieved. This implies not only a good knowledge of the duties of the entire staff, but also the ability to anticipate the outcome of a visit, thereby planning its duration allocated in the agenda (Figure 1.4).

In general the day comprises general and preoperative examinations and check-ups (postoperative and others), scheduled in the agenda on the basis of the surgery conducted. Having set out the surgical calendar, the examination days are planned. Normally no examinations are scheduled during surgery day, in order that the whole staff (clinical and non-clinical), can devote themselves entirely to patient management. Even the day after surgery is organized so that the first part of the morning is reserved for those patients operated on the previous day.

Together with this procedure the Front Desk staff has to be able to manage all the incoming calls: Some of these may involve altering the day or time of a fixed appointment, but most of them egard refractive surgery. The callers usually ask for information regarding: Time needed to fix a consultation, What to do before the consultation, Cost of the visit and the time required for surgery if it is deemed appropriate.

It is obvious that the more we communicate with our callers the more open and honest will be the exchange of information. It is also important to underline that sometimes aspiring patients, are not necessarily good candidates for surgery – (see physical/clinical and motivational requirements assessed by the clinical and patient care staff).7

The role of the Front Desk staff is to be helpful, informative, relaxed, and cheerful where appropriate, but most of all they must possess a high degree of knowledge pertaining to of the specific subject and must transmit confidence: Only this way can one hope to gently persuade the patient to make an appointment for a consultation, without imposing any pressure so to do. Front Desk staff must be able to discover, analyze and recognize patients emotional needs, state, fears, frustrations and be able to play an active role in the patient's exploration of options regarding refractive surgery. It may seem trivial, but not only does the choice of words used play an important role, but also the voice of the person speaking with the patient to establish communication. The importance of establishing true communication is highlighted in the preoperative phase during the interview with the Patient Care staff.

A precise yearly plan regarding the use of the media to market the company services and products is fundamental for attracting customers and ensuring that the company reaches, and stays in, the public eye (Figure 1.5).

As far as a health company is concerned, marketing still remains an important expense, but some qualifications are necessary. First of all, it must be clear what we are talking about. We are not discussing marketing in a public health environment, such as a hospital or an emergency room for example. What leads people towards these places is necessity or urgency (pain, a sudden health problem, or the need for special services that only large public services can offer). This kind of health service cannot be compared to a private one, if we consider dimensions and core business.

The topic that we want to analyze in this chapter is marketing in a private health company that offers those services and practices that are not “urgent”, that are not geared towards saving a patient's life. Of course, such health centers offer clinical practices that undoubtedly greatly improve a patient's quality of life, but they are not of primary importance for the continuation of life.8

In this specific case, we aim to analyze the distinctive qualities of the external relations department of a vision institute, which offers different services and technologies to restore patients' vision. The external relations department must constantly maintain a fine balance between the need to promote services offered by the institute and the necessity to abide by the dictates of the law in this delicate matter. We will start by analyzing the Italian regulations for publicity in health.

The ethical code of conduct in professional practice of 1999 sums up the main legal concepts regarding publicity in health (which was the modification of a previous and more stringent law of 1992). It has been reported previously and gives us a clear idea of what the general trend of the law in Italy is: The medical doctor, in this case the refractive surgeon, shall not promote the public or private heath structure where he/she professionally operates, through the most common media (newspapers, magazines, television). Information in the health sector may not present any of the typical features of commercial publicity (Figure 1.6). This is meant, of course, to guarantee a professional health system to all the citizens, avoiding the possibility that financial enterprise in health services could mitigate against quality in these same services. It is, of course, correct to regulate the marketing and the publicity in such a delicate area, considering that often people's lives depend on the quality of the services they get in hospitals or in private health companies.

As mentioned, the regulation in 1992 was even more stringent: The only kind of publicity allowed was the doorplate (with the name of the doctor and his/her academic titles) and informative articles only in sector publications. Furthermore, even the doorplate had to be approved by the Public Body and by the local Medical Board Association. In 1999 the law relaxed somewhat, additionally allowing 9doctors to publicise in any general magazine, including those publications that we usually find in bookshops. This made things easier for those companies that offered private health services, who could now use the media in a different and more profitable way.

Of course, the doctor is not completely free of bias and cannot say or write anything he likes in any newspaper or magazine, but now he has the possibility of publishing the “Services Chart” of his private company without needing any permission to do so.

What is the most delicate issue in the external relations department of an innovative center such as a full service vision institute? The balance between scientific information (characterized by specificity of terms, mathematical and statistical analysis of data, and for this reason not really attractive to the public) and marketing (characterized on the contrary by a fresh and user-friendly language, colored pictures, easy concepts). This balance is sometimes very hard to find.

The Patient Care staff plays an essential role in an Institute devoted to the correction of visual defects. Its main aim is to provide patients with accurate and comprehensive information regarding surgery, often with a view to clearing up the confusion patients frequently have on the subject.

One of the main prerogatives of the Institute is to assist the patient affected by a visual problem or defect right through from the very first preoperative consultation to the last postoperative examination.

The Patient Care staff aims to help the patient to understand his personal visual situation, his desires, his expectations and must also satisfy his requests and answer any questions he may have concerning surgery.

Assuming the patient's clinical suitability, could a patient nevertheless not reflect suitable “psychological parameters” and have expectations which are incompatible with the results that refractive surgery could offer?

Confirmation of a patient's suitability for surgery is therefore made via an appropriate assessment of his/her motivation.

To evaluate the patient's motivation for the surgery the Patient Care staff must pay attention to his behavior during the consultation, assessing his expectations, doubts, desires and fears. To overcome fears of surgery for example, it is necessary to describe the procedure step by step to the patient, using appropriate terminology, method and tone of voice. It can also prove valuable to refer to the fact that some of the staff of the institute have also undergone eye surgery.11

It is evident that people bringing different knowledge and different professions working in the same center can represent a wide gamut of important resources to meet patient's needs and can foster a cooperative working atmosphere.

This briefing allows the medical staff to enjoy a mutual exchange of ideas with the non-medical staff and to strive to reach the optimal solution for each patient.

The FD (PC) staff knows much about the patient, not only through what is written in his case history (taken when he first came to the Institute) but also has an understanding of his true needs and whether he has particular fears, expectations or anxieties. Such elements can help the medical staff to satisfy such needs.

What makes the relationship between the medical and non-medical staff relevant is that the FD staff is constantly evaluating and streamlining the management of timing during daily consultations with the consequence that patient waiting times are reduced (Figure 1.9).

The role of the FD staff is also to organize the movement of the patients within the Institute and thereby avoid bottleneck situations (often arising from high patient numbers) both in the waiting rooms 12and other areas. When patients arrive they are split into two waiting rooms and it is the task of the front desk staff to make note of those present and direct them to the appropriate examination rooms.

The logistics of patient management during surgery times changes rhythm fundamentally with respect to examination days. One of the two waiting rooms is dedicated to patients awaiting surgery and their accompanying persons; the other room is appropriately darkened to prevent any intense external light entering (an immediate postoperative requirement). This room is designed to receive the patient after surgery, providing a reserved space which is calm and relaxing, where some time can be spent with those accompanying him, before they leave the Institute.

The medical staff has a great influence on the work of the FD because it can provide key education and training to impart specific knowledge which will prove especially useful when talking to the patient regarding treatment following the consultations or when managing patient needs in the immediate postoperative phase. During this particular phase, the patient needs to have a point of reference, somebody to talk to, and before speaking to the Patient Care staff (devoted to that very task) he can be sure that he is speaking to somebody who immediately understands him, and when and what kind of surgery he had. We could even talk of an “art of listening” that characterizes the FD (and Patient Care staff). Not least because another vital aim is that of being able to recognize, from a description of symptoms on the phone, any potential complications (after surgery or after therapy) and so be in a position to provide appropriate medical advice.