There was an ¼ inch elevation in the transition from the sidewalk to the driveway, right next to where cars would back up for me to hand carry 25 lbs. of awkwardly sized large and typically dirty mulch bags to the trunk of customers at the family-run hardware store where I worked as a stock boy when I was 14. This would become the stage for a business revelation that would stay with me for my entire career as an entrepreneur ophthalmologist. One day, I tripped on the concrete elevation, or bump, and fell hard: bags of mulch flew with me and rolled away as I scraping elbows and knees on the concrete. Embarrassed, I brushed the pebbles from my bleeding knees, picked up the bags and put the mulch into the backed-up car's open trunk.
But then, there was an interesting consequence: I got a tip for my trouble. After being on the job for 2 months, it was the first time a customer walked over and gave me a tip. It was just a dollar, but in the early eighties, that was enough. That day, when my shift was over, I stayed late and practiced falling on the bump in the concrete so that I could perform it for every future mulch bag delivery. I had realized that learning to fall was an essential part of work.
Stumble Often; It Will Hurt Less Over Time
Entrepreneurs in any business sector expect setbacks; failure is part of the process. Calculated risks are the only way to grow a practice and integrate innovation in medicine. Striving for perfection in every non-medical decision only means change will not happen. How do you accept setbacks on projects and decisions that are not going as initially expected? How well do you prepare to fall?
The key is acknowledging that not all decisions will go perfectly. Next, work with your team to manage expectations at the onset, define metrics to measure progress incrementally along the way, and then establish when those metrics must either be met or the project abandoned.
Here is an example of how learning to fall made me better at my practice. I opened a satellite office in the next county to expand my referral network for cataract surgery. It took me 2 years failing to meet target growth to learn that the referring doctors hesitated to send me patients. Many initial patients returned to their referring optometrist complaining about traveling to my other surgical center in the next county for surgery. I thought traveling 35 minutes was not a big deal, but I should have realized that this was added to the 20-minute drive to my office already. In Baltimore, people like to stay close to home.
Patients and referring doctors didn’t tell me this, but their reluctance was causing my plans to fail. The absence of or wrong information is toxic to any business. The new office failed because I believed patients would travel for surgery, but I did not solicit the referring doctors about their beliefs. I was able to catch this setback early enough by establishing monitoring metrics, such as the number of new patient consults and surgical volume specific to this new office.
This triggered the next step: softening the fall and finding more robust ways to get back up. I knew the answers would come from the streets and decided to block out time to meet with referring doctors to flush out the roadblock for referrals. It took many meetings for one or two providers to finally tell me their concerns about taking their patients across town for surgery. I then circled back to confront several referring providers only to have them confirm that the main objection was travel for surgery. To get back up, instead of abandoning the new office, I doubled my investment in this office to create an attached surgical center, hoping that famous line, “If you build it, they will come” would come true for me. After learning that my target audience’s opinion was more important than mine, this office became my busiest location. Failure or struggle is always painful and defeating, but also an opportunity to learn or grow. Consider the lost revenue or sunk cost as tuition payment.
Go Ahead, Give It a Try — Knowing It's Okay to Fall
Learning to fall is a positive approach to entrepreneurial initiatives and should not be perceived as focusing on the negative. Having a strategy when your plans are not going well will reduce anxiety and even open the door for more opportunities. My team walks the clinic's halls expecting fires each day, so when they occur, we are calm and ready to react. This concept should be pervasive in all decisions to create a best-in-class practice.
A minor example is the creation of a dry eye clinic in our office. We purchased equipment for the office, and providers set up protocols, created block time, and even went to meetings for advanced training. After 2 months, calls started coming in from several referring providers, reminding us that they treat dry eye and want us to stay in our lane, which typically involved cataracts and glaucoma surgery, and then refer them back for all other care. We had to reduce the clinic appointments by 70% for this new initiative and learned that external providers were just as vital as our internal providers. Preserving the relationships was more important than internal growth for dry eye.
Shades of Gray
In health care, patient treatment is never compromised, and plans are always black and white with the expectation of success. However, the business of medicine has become grayer, with opportunities only coming with some level of expected risk. In this environment, perfection becomes paralyzing, so providers need to start small and then expand opportunities to fall safely.
Back to the bump in the concrete ... by the end of the summer, my adult co-workers would line up by the window looking out at the cars backing up in the driveway, waiting for my dramatic fall and the mulch bags to splay in all directions. They started rating my performance on a scale from 1-10, just like in the Olympics. My learning to fall began accidentally, evolved into entertainment for my co-workers, but ultimately became a core principle in my journey as a serial entrepreneur ophthalmologist. OM
