บทถอดความฉบับเต็มของ How To Engineer Patient Compliance With Kerry Reeves, OD

was working in that practice. 00:02:27.599 --> 00:02:36.000 We practiced about 10 years with a group practice, two older doctors, and then we brought on a couple of younger associates. 00:02:36.719 --> 00:02:43.520 We would buy retiring doctors' practice and then kind of go from there. 00:02:43.680 --> 00:02:54.400 I did that about a decade, and then somehow found myself selling everything we owned and moving to Haiti to be medical missionaries. 00:02:55.039 --> 00:02:58.639 The biggest and best thing I've ever done in my life. 00:02:59.360 --> 00:03:07.280 Just the difficulty was six months after we got there was the earthquake in 2010. 00:03:08.560 --> 00:03:15.280 And so my eye care stuff kind of got put on the back burner because everything was broken. 00:03:16.000 --> 00:03:35.120 And so, but I did learn there about something called systems, and that's where I started working with systems with bottlenecks and feedback loops and and all of those kind of things to try to help rebuild what had happened during the earthquake. 00:03:35.280 --> 00:03:39.439 And so then we spent about five years there doing that, moved back to the U.S. 00:03:40.319 --> 00:03:45.280 And I practiced in a cataract surgery ophthalmology practice for about five. 00:03:45.680 --> 00:03:55.360 Moved back to my wife's home state of North Carolina, and now we're in Fayeville, and we have a small practice in Myrtle Beach, South Carolina. 00:03:55.680 --> 00:03:57.280 Man, you've been all over. 00:03:57.680 --> 00:03:59.759 That's my journey in a nutshell. 00:04:00.400 --> 00:04:03.919 And and mom is happy with your yeah, yep. 00:04:04.000 --> 00:04:05.199 She was satisfied with it. 00:04:05.439 --> 00:04:09.840 Did you, when you were mom said you're gonna be a doctor, did that resonate for you? 00:04:10.000 --> 00:04:12.800 Did you feel like, yeah, I think I could see that? 00:04:13.520 --> 00:04:17.519 As a kid, the primary thing is to please mom. 00:04:18.560 --> 00:04:25.120 I just knew that I enjoyed academics, I enjoyed school, I was a studier, I enjoyed that kind of thing. 00:04:25.279 --> 00:04:33.839 So and my mom was an educator, my dad's an educator, and so school was just part of our DNA. 00:04:33.920 --> 00:04:36.240 And so I didn't mind the school side of it. 00:04:36.560 --> 00:04:40.800 How has it been for you, you know, being independent and having your own business? 00:04:41.120 --> 00:04:49.279 You know, I hear a lot from you know, independent business owners, eye care business owners, that that it's it's tough out there. 00:04:49.600 --> 00:04:51.439 I wouldn't trade it for anything. 00:04:51.920 --> 00:05:06.480 If I mean picking to do independent, owning my own practice, the buck stops with me, I get to make the decisions, decide on how things go, where they go. 00:05:07.360 --> 00:05:08.639 I love all that. 00:05:09.519 --> 00:05:44.079 But just like everybody else, I don't like all the payroll taxes and you know, and the little things that go along with it every day, but I still think it is the biggest best thing in optometry is that it allows doctors who want to go that route, who want to be an operator and own their own a business, and have you can have retail, you can have medical, you can do specialties, so many different ways. 00:05:44.240 --> 00:05:47.839 Yeah, and so that's the best part about optometry is it allows us to pick that. 00:05:48.160 --> 00:05:50.240 You know, and I think it takes a special person. 00:05:50.319 --> 00:05:57.199 You kind of alluded to that, that you know, it it's an it's an option, and only certain people, you know, take that route. 00:05:57.360 --> 00:05:57.920 What do you think? 00:05:58.000 --> 00:06:02.639 Well, what is it about you, or what is it about a doctor who wants to be independent? 00:06:02.720 --> 00:06:07.920 You think that I think it's just that typical entrepreneurial spirit. 00:06:08.959 --> 00:06:16.639 I mean, I've owned an embarrassing amount of endeavors through the years. 00:06:17.040 --> 00:06:21.680 I've owned a limo company, a pillow company. 00:06:21.920 --> 00:06:38.079 I think it takes that entrepreneurial spirit of I want to own the business, I want to deal with the intricacies of it, and and I want to reap the benefits of owning something and building something. 00:06:38.160 --> 00:06:39.920 I'm a I think it takes a builder. 00:06:40.000 --> 00:06:42.560 I mean, I've my dad was a builder. 00:06:43.439 --> 00:06:46.319 He owned a construction company when I was growing up. 00:06:46.720 --> 00:06:51.519 And so I grew up pulling nails and carrying shingles and building stuff. 00:06:52.079 --> 00:06:57.040 And so I think this is part of what I still do, is I get to build this thing. 00:06:58.160 --> 00:06:59.920 Yeah, no, I love that. 00:07:00.079 --> 00:07:07.360 And I think it it does attract a certain type of person and you know, someone who's a creator and a builder. 00:07:07.439 --> 00:07:11.920 And you know, speaking of building, you've built this book here, the follow-through gap. 00:07:12.560 --> 00:07:21.920 And I thought, you know, when I saw on LinkedIn that you had written this book, I thought, okay, he's he's out there, he's creating content, but now he's got a book. 00:07:22.000 --> 00:07:25.199 So that is a whole, you know, that's a huge leap, right? 00:07:25.519 --> 00:07:30.639 You you have got to put a lot of thought into your craft to write a book. 00:07:30.800 --> 00:07:31.680 So I don't know. 00:07:31.759 --> 00:07:33.759 Tell me what spurred you to create. 00:07:34.240 --> 00:07:34.879 The problem. 00:07:35.439 --> 00:07:35.759 Okay. 00:07:36.160 --> 00:07:48.639 We are super smart, we are super trained, we got the coolest tools and toys and gadgets to make great diagnoses. 00:07:49.519 --> 00:07:56.399 Then we tell the patient what to do to get better, but they don't. 00:07:57.839 --> 00:07:59.600 For whatever reason. 00:08:00.480 --> 00:08:11.519 There's, you know, we go through the book so many different

reasons why patients don't go from our diagnosis to the outcome that we want and they want. 00:08:12.480 --> 00:08:12.959 Right. 00:08:13.279 --> 00:08:22.079 And I discovered that way too much of the time for me, I said, You're noncompliant. 00:08:23.279 --> 00:08:25.279 That's why you're not better. 00:08:26.000 --> 00:08:32.559 I could abscond all my responsibility because my job stopped at the exam. 00:08:33.840 --> 00:08:40.559 If the patient didn't do what I said afterwards, well, then that just meant I get to charge for another office visit. 00:08:41.679 --> 00:08:59.200 But I got tired of that and began to say, I know as a systems guy, if something keeps happening over and over, it's not a person problem, it's a system problem. 00:09:00.000 --> 00:09:05.919 So I started looking at what is the system producing this recurrent outcome. 00:09:06.799 --> 00:09:38.399 And that's where the book came from is the investigation into those systems and coming up with a way to build rails from diagnosis to desired outcome of whatever their problem is, which can be dry eye, glaucoma, myopia, you know, whatever's going on, or even an optical of glare at night and you know, whatever else kind of things, or computer users and screen time. 00:09:39.759 --> 00:10:03.519 And so I started telling myself a recommendation is not an actual care plan, and it's just hoping for this to work, and hope is not a system, and so I developed specific care plans for pretty much every diagnosis that I would be making. 00:10:04.720 --> 00:10:17.840 How do I get from the diagnosis to the desired outcome and me own that from the time they get the diagnosis to the time the outcome is achieved? 00:10:18.080 --> 00:10:19.519 I have to own it. 00:10:20.159 --> 00:10:20.559 Yeah. 00:10:20.879 --> 00:10:28.639 So I thought, let's write this down and let's have some people argue with me about it or talk about it. 00:10:28.799 --> 00:10:31.440 And there's even a chance it might help somebody else. 00:10:31.519 --> 00:10:32.320 Who knows? 00:10:32.639 --> 00:10:42.320 And so, you know, and that's that was the whole push behind the book was to get that thought out there to say that I personally believe there's a problem with how we do medicine. 00:10:43.120 --> 00:10:51.360 As you were talking, you know, you talked about your experience in Haiti and how you began to notice systems issues. 00:10:51.600 --> 00:10:55.440 I'm curious, is there something from your experience in Haiti that stands out? 00:10:55.600 --> 00:10:59.279 And you said you got into you had to get into non-ICARE stuff, right? 00:10:59.440 --> 00:11:00.159 Yeah, yeah, really. 00:11:00.480 --> 00:11:10.720 What what's maybe like so tell me an experience you had in Haiti that really was an aha moment about systems and how systems could really make before daybreak one day? 00:11:11.039 --> 00:11:35.440 This friend of mine who's a Haitian fisherman showed up at our where we were living, and I climbed into a little wooden rowboat, about six inches of water, sloshing around in the bottom because it would leak all the time, little bait fish swimming around my feet, and and Clorox jugs with fishing line wrapped around them with a hook on the end. 00:11:36.240 --> 00:11:45.919 And so the weed paddled out into the ocean for about an hour, and then began to bait these little jugs with little bait fish and throw them into the ocean. 00:11:46.559 --> 00:11:56.159 And we sat there for several hours, and when the bait fish would die, I I would take it off and I was gonna throw it back. 00:11:57.120 --> 00:12:10.000 And Roger stopped me and he took that little dead bait fish from me and he laid it on the bench beside him, and he said, if we don't catch fish today, this is dinner for my kids. 00:12:10.399 --> 00:12:20.320 But then we got back to the we got back to the little village where he spent the entire day trying to sell it and couldn't sell the fish. 00:12:21.519 --> 00:12:36.960 And so what I began to what kind of clicked in me was hardworking, intelligent, committed, well-trained individuals can still fail in a broken system. 00:12:37.600 --> 00:12:40.480 And so what we began to do was build a system. 00:12:41.120 --> 00:12:51.519 Their problem was there was no refrigeration, there was no transportation, and there was no way to build a market for the fish. 00:12:52.480 --> 00:13:15.600 So I started, I built a refrigeration system, I hired women to process the fish, and then I would take the fish and sell it to orphanages, NGOs, other groups that needed food for feeding programs, and then connected those fishermen to those groups. 00:13:16.480 --> 00:13:23.120 But it took a very deliberate system for that to all work out. 00:13:23.759 --> 00:13:30.879 And so then I moved back to America, moved work, started working in ophthalmology practice, and man, it was high volume. 00:13:31.039 --> 00:13:35.519 They were seeing so many people and so much happening, but it went great. 00:13:35.679 --> 00:13:38.320 And they treated so many people, and it was good. 00:13:38.559 --> 00:13:51.360 And I started seeing, okay, it's because they have systems compared to my previous optometry career, where I didn't have as good a system and saw some failures and things. 00:13:51.600 --> 00:14:03.519 And so I began to say, hey, this systems thing is not about just fish in Haiti, it's about health care, my personal life, businesses. 00:14:04.399 --> 00:14:07.519 And man, once you start seeing systems, you can't unsee it. 00:14:08.480 --> 00:14:09.600 You can't get away from it. 00:14:10.000 --> 00:14:11.679 That's kind of how it all started. 00:14:12.159 --> 00:14:12.399 Okay. 00:14:12.639 --> 00:14:12.879 Amazing. 00:14:13.120 --> 00:14:24.240 You have an amazing thing that that stood out to me from your book was this idea of creating an identity in the person, right? 00:14:24.320 --> 00:14:28.000 That whose behavior change you're trying to establish. 00:14:28.320 --> 00:14:35.360 Where did

you come up with this idea of creating identity, you know, helping someone frame a new identity? 00:14:35.600 --> 00:14:44.159 We're dealing with people every day that have problems, they have issues, they can, yeah, they got our problems, but they got other stuff too. 00:14:45.039 --> 00:14:51.039 And I'm also the dad of eight children, and I've got nine grandchildren. 00:14:51.759 --> 00:15:15.200 And identity is one of the things that I try to instill into my kids is helping them have a strong identity of who they are, so they're not just floating around to whatever somebody else says they are, especially with social media and all that stuff, trying to define identity. 00:15:15.679 --> 00:15:35.840 And so I've decided to implement systems into my practice that also helps my patients have a specific identity that helped them to achieve the outcomes that they need to achieve as an eye care patient. 00:15:36.080 --> 00:15:57.360 And so the same thing, just like I took it for my kids and understanding the power of identity, the importance of identity, and then saying, let's use that same need psychologically to help them use their drops better and do lid scrubs and you know and follow through with what we recommend. 00:15:58.799 --> 00:16:00.799 So let's flesh that out a little bit. 00:16:00.960 --> 00:16:07.120 What does that mean to what does that mean to create that identity in a, let's say, a dry eye patient? 00:16:07.360 --> 00:16:09.519 And how do you go about doing that? 00:16:09.759 --> 00:16:16.080 When I'm working with a dry eye patient, I'm not necessarily thinking as much about the identity aspect of it. 00:16:16.240 --> 00:16:20.799 That's more of an underlying backside of the system. 00:16:22.559 --> 00:16:28.240 What I'm thinking of is there's eight pieces to a care plan. 00:16:28.720 --> 00:16:37.759 And so I'm gonna build that plan for this particular patient to help them reach the outcome. 00:16:38.960 --> 00:16:44.960 We get so focused on the diagnosis that the outcome is an afterthought. 00:16:46.399 --> 00:16:49.200 The outcome should be priority. 00:16:50.320 --> 00:16:53.039 Number one, the most important thing. 00:16:53.840 --> 00:17:02.240 And so if we're thinking about it that way, so we take the patient and immediately think, how we're gonna get them to the outcome we're looking for. 00:17:03.519 --> 00:17:08.720 And then we think, okay, this care plan is gonna be the transportation mechanism. 00:17:09.279 --> 00:17:29.200 It's gonna be the rails, it's gonna get them from my super bright, brilliant, thoughtful diagnosis, and use I'm not gonna have to rely on that because I've got this entire system to get to the outcome. 00:17:29.519 --> 00:17:30.160 Yeah. 00:17:30.960 --> 00:17:40.000 I love that idea of hey, we're focused on this outcome, and you know, how do I get you bought in to this? 00:17:40.720 --> 00:17:49.680 And how do I create the how do I create the environment that is gonna help you achieve but it's also what I've discovered. 00:17:50.480 --> 00:17:58.160 Most patients don't sit there and say, nah, I don't want to do your, I don't want to do take your recommendation. 00:17:58.319 --> 00:17:59.680 I don't want to take your recommendation. 00:17:59.920 --> 00:18:01.759 No, I I don't I don't think you're right. 00:18:01.920 --> 00:18:06.960 I I don't think they say, yes, yes, man, thank goodness. 00:18:07.119 --> 00:18:09.839 I've been trying to find somebody to help me with this problem. 00:18:10.240 --> 00:18:11.599 Thank you so much. 00:18:12.880 --> 00:18:23.759 But before they get to their car, after they leave my door, they get 37 notifications on their telephone, and immediately life hits. 00:18:24.559 --> 00:18:36.160 And they didn't plan to not buy the drop, they didn't plan to not do the hot compresses, they didn't plan to not have their kid wear their stellus lenses as much as they should. 00:18:36.319 --> 00:18:39.200 That wasn't the the I they didn't decide that. 00:18:39.759 --> 00:18:41.119 That's life. 00:18:42.079 --> 00:18:49.599 So what we try to do is help them put anchors in their life to make that easier. 00:18:49.839 --> 00:19:00.000 In Haiti, we developed this whole system framework called system flow, and the number one sort of piece to it is the system wins. 00:19:01.200 --> 00:19:06.559 There's a system winning in every outcome that's being produced. 00:19:07.519 --> 00:19:19.200 The system is going to win, but we just have to identify the system and then modify the system to reposition the outcome. 00:19:20.000 --> 00:19:26.799 So one of the things like one of the steps in developing a care plan is is anchors, lifestyle anchors. 00:19:27.119 --> 00:19:29.920 I talk to a patient and say, so tell me about your morning. 00:19:30.720 --> 00:19:31.920 Do you drink a cup of coffee? 00:19:32.079 --> 00:19:33.279 Do you brew your coffee? 00:19:33.519 --> 00:19:34.240 What do you do? 00:19:34.559 --> 00:19:36.160 Okay, so here's what we're gonna do. 00:19:36.319 --> 00:19:38.960 I wanted you to use this drop four times. 00:19:39.599 --> 00:19:42.480 And I want you to do this hot compress twice a day. 00:19:43.519 --> 00:19:46.480 So you're gonna buy two bottles of drops before you leave. 00:19:47.200 --> 00:19:49.759 One bottle put by your toothbrush. 00:19:50.720 --> 00:19:55.519 Because that way, morning and night, you're not gonna forget because it's sitting there. 00:19:56.400 --> 00:20:01.839 The other bottle you're gonna keep with you and do it lunchtime and when you get off work. 00:20:02.640 --> 00:20:13.039 Then while you're brewing your coffee, take this little mask, heat it up in the microwave, and while it's brewing, you hold that on your eyes. 00:20:13.759 --> 00:20:20.880 And so now that patient is not just, I said, let's get this in your life, let's put some anchors in your life. 00:20:21.440 --> 00:20:27.039 And then we have a follow-up mechanism where they can let us know if it's working. 00:20:27.680 -->

00:20:29.759 And if it's not, we can readjust. 00:20:30.079 --> 00:20:31.440 We need reminders, right? 00:20:31.519 --> 00:20:39.680 Like we need to un you've got to understand the obstacles that are gonna come up for you, and how are you gonna overcome those obstacles? 00:20:40.000 --> 00:20:45.920 And you're kind of you're kind of doing that by saying, you know, hey, you're gonna forget. 00:20:46.000 --> 00:20:48.480 Let's let's create let's create a plan here. 00:20:48.720 --> 00:20:49.039 That's right. 00:20:49.119 --> 00:20:52.079 But M and System Flow is memory failure. 00:20:53.359 --> 00:20:55.359 You can't depend on memory. 00:20:55.680 --> 00:20:56.720 Yeah, that's for sure. 00:20:56.880 --> 00:20:58.319 He's number one of that right here. 00:20:58.480 --> 00:21:00.640 No, you're case number two, because I'm case number one. 00:21:01.039 --> 00:21:18.240 You talk in the book about systematizing within your own teams, because if one team member communicates the plan in a kind of a wishy-washy way, that that compromises the system. 00:21:18.319 --> 00:21:22.160 So, how do you keep your team aligned with that? 00:21:23.359 --> 00:21:26.799 Bottom baseline is good SOPs. 00:21:27.920 --> 00:21:32.640 You gotta have standard operating procedures for everything that you want to happen. 00:21:33.200 --> 00:21:40.400 Then the you've got to realize the systems we're talking about are not just the patient follow-through systems. 00:21:41.680 --> 00:21:53.519 If I notice the front desk continually does something that's a negative outcome, that's not that person that's failing, that's the system failing. 00:21:53.839 --> 00:21:58.640 And so I've got to restructure the system to produce the outcome I want. 00:21:59.440 --> 00:22:03.200 And And a lot of times that's not just educating them. 00:22:04.319 --> 00:22:07.599 The first thing is something called easy happens. 00:22:08.799 --> 00:22:12.400 Human nature, we're going to go to path of least resistance. 00:22:12.960 --> 00:22:25.440 And so if in my culture at work, I'm saying this is the most important thing, but in reality, this is what I actually emphasize on a daily basis. 00:22:25.599 --> 00:22:30.160 Well, then they're going to go to where I emphasize things, not what I said. 00:22:31.440 --> 00:22:40.079 And so it's realizing that any outcome in your business that's over and over is coming from a system. 00:22:41.119 --> 00:22:45.279 And so you can find what's causing it, then you restructure it. 00:22:45.440 --> 00:22:53.680 So taking a person, and what we've done too much as business owners is try to find a person to blame. 00:22:54.720 --> 00:22:56.559 Because, you know, that's easier. 00:22:56.720 --> 00:22:59.279 It's kind of human nature. 00:22:59.599 --> 00:23:04.880 But if it's over and over and over, you can probably replace that person and it's going to still happen. 00:23:06.079 --> 00:23:07.599 Unless they're a hero. 00:23:08.000 --> 00:23:13.200 You know, but you also that's the best way to break your system, too. 00:23:14.319 --> 00:23:16.240 Have one that depends on a hero. 00:23:16.880 --> 00:23:26.960 Have a system that requires an MVP employee, and it's you're going to have issues because that they're not always going to be there. 00:23:27.200 --> 00:23:29.680 They're going to have issues other ways. 00:23:29.839 --> 00:23:40.400 And so it's all just it's not it's getting every employee on board with saying, let's find what is causing this. 00:23:41.039 --> 00:23:42.480 And then they get used to it. 00:23:42.880 --> 00:23:46.480 They get used to that philosophy of what's causing this. 00:23:46.720 --> 00:23:50.960 And they like it because I'm not saying you keep doing this. 00:23:51.839 --> 00:23:53.759 I'm not blaming them. 00:23:53.920 --> 00:23:55.599 And they don't blame me. 00:23:56.319 --> 00:24:00.480 We say what keeps happening, and then okay, what's causing it? 00:24:00.720 --> 00:24:02.400 What can we change? 00:24:02.720 --> 00:24:03.359 Yeah. 00:24:03.839 --> 00:24:10.160 It reminds me of, I don't know if you've heard of lean, lean process improvement or Toyota. 00:24:10.480 --> 00:24:14.559 Uh, let's get a process, let's engineer it so it's mistake proof. 00:24:14.960 --> 00:24:20.400 Let's find out from the employees, the frontline people, like what works and what doesn't. 00:24:20.640 --> 00:24:27.519 And it's very pragmatic and human-centered, and but it's system centered, you know. 00:24:27.680 --> 00:24:28.000 Right. 00:24:28.160 --> 00:24:29.920 Yeah, we could we could talk on this topic. 00:24:30.240 --> 00:24:30.960 I could, I will. 00:24:31.279 --> 00:24:32.559 As long as you want to go, buddy. 00:24:32.640 --> 00:24:33.440 I'm in. 00:24:34.000 --> 00:24:35.440 I encourage everyone. 00:24:35.599 --> 00:24:38.640 I've I have read through the follow-through gap. 00:24:38.799 --> 00:24:54.160 I think there are some really powerful ideas in here, not just for you know medical optometry and ophthalmology, but just life in general and and people management. 00:24:54.480 --> 00:24:59.599 Um, there's a little bookstore called Amazon.com. 00:25:00.319 --> 00:25:00.559 Okay. 00:25:00.799 --> 00:25:03.359 And they and Jeff, my friend Jeff over there at Amazon. 00:25:03.519 --> 00:25:04.880 Uh Jeff, okay. 00:25:05.039 --> 00:25:05.200 Yeah. 00:25:05.279 --> 00:25:06.799 And so you can get it on Amazon. 00:25:06.960 --> 00:25:16.079 You can also go to thesystemflow.com and you can get it there, see what we're working on, see what kind of crazy ideas we've got going on. 00:25:17.039 --> 00:25:19.519 And then also through LinkedIn. 00:25:20.319 --> 00:25:22.240 Just Carrie Reeves O D. 00:25:23.519 --> 00:25:23.839 Okay. 00:25:24.079 --> 00:25:24.240 Yeah. 00:25:24.319 --> 00:25:31.680 And I'll, you know what, I'll put the link into the show notes for people to connect with you through through LinkedIn. 00:25:31.920 --> 00:25:32.960 But yeah, thank you. 00:25:33.119 --> 00:25:35.440 Thank you, Carrie, so much for your time. 00:25:35.759 --> 00:25:36.960 Thanks for your podcast. 00:25:37.119 --> 00:25:39.920 Thanks for the effort it takes to produce this thing. 00:25:40.160 --> 00:25:41.279 We we appreciate it. 00:25:41.359 --> 00:25:44.240 Us iDoctors out here trying to do the business stuff. 00:25:44.559 --> 00:25:49.119 We love the stuff that you bring on, the points you bring out constantly. 00:25:49.359 --> 00:25:52.160 So keep pushing it out, buddy. 00:25:52.240 --> 00:25:53.599 It's looking, we love it. 00:25:54.640 --> 00:25:59.680 Well, that brings this episode of iCare Leadership Live to a conclusion. 00:25:59.839 --> 00:26:08.000 If you enjoyed this episode, please subscribe to the show on your podcast app and share it with someone who would value the content. 00:26:08.240 --> 00:26:14.720 I promise to bring you more guests and content to help make you a better eye care clinical leader. 00:26:14.960 --> 00:26:19.279 I also invite you to subscribe to my HR newsletter for iCare leaders. 00:26:19.440 --> 00:26:23.519 You can find information about that at seasoned advice.com. 00:26:23.680 --> 00:26:26.799 Now go out there and lead with confidence.