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Cover Focus | Sept/Oct '19

Cultivating a Positive Work Culture

What if you wanted to create the best company in the world to work for? Would it function like your favorite hotel chain or theme park? Would your business land on Forbes list of the top 100 places to work? The real question is this: Would it look like your clinical practice today?

This is something that ophthalmology practices, which function as small businesses, must focus on now more than ever. Many practices strive to create the optimal patient experience, but at the heart of every great patient experience is a staff whose members enjoy and feel valued at work.

High staff turnover can be detrimental to a busy practice. Promoting a positive, healthy work environment not only encourages staff retention but also helps practices become more efficient over time. As we evolve to meet the growing number of ophthalmology patients, how can we build a thriving patient-centered practice that also promotes a healthy work environment?

In an article in Harvard Business Review, researchers Rob Goffee and Gareth Jones describe their research and surveys on this topic and their efforts to understand the relationship between authenticity and effective leadership.1 According to these authors, “the organization of your dreams” is a company “where individual differences are nurtured; information is not suppressed or spun; the company adds value to employees; the organization stands for something meaningful; the work itself is intrinsically rewarding; and there are no stupid rules.”

Not surprisingly, when I set out to identify the initiatives we use at Warrenville EyeCare & LASIK to promote a healthy work environment, I found myself echoing many of the basic principles behind these core values. In short, to promote a healthy work environment, an ophthalmologist must be a LEADER. Let’s look at this in greater detail.


First and foremost, the drive to create a positive work environment lies with the captain of the ship. The ophthalmologist sets the tone for how the rest of the practice functions. You can create a strong, positive culture when you lead the way with a healthy attitude and a cheerful demeanor. You may be surprised by how influential a few words of acknowledgement and encouragement can be.

For example, how do you greet the members of your staff when you walk in the door in the morning? If you start out with a genuine smile, they will reciprocate. As simple as that sounds, it sets the tone for the day. Many top practices begin the day with a team huddle or prayer. It takes only a few moments to emphasize and encourage your ophthalmic team and focus positively on the patients you will be seeing that day.


Many practices focus on staff education to encourage a positive culture. The greater the level of education, the more the staff members will appreciate the importance of their roles to deliver quality care. Often, members of the staff who are natural teachers will excel when given opportunities to engage in peer-to-peer learning.

At my practice, we hold regular staff educational sessions on disease state awareness, diagnostic testing, and treatment options. My staff’s knowledge of the diseases I treat and the procedures I perform has grown tremendously in the past few years, directly as a result of these sessions. Further, it has allowed staff members to take on greater roles to help educate our patients. This has a positive impact on both patient comfort levels and staff morale.


Appreciation is another cornerstone of a healthy workplace environment. Studies have shown that higher levels of gratitude were associated with higher levels of personal well-being, greater life satisfaction, and lower levels of psychological distress.2 Further, experiencing feelings of gratitude causes release of important reward neurotransmitters such as dopamine and serotonin that encourage us to repeat those behaviors.3 Indeed, we have no doubt experienced this personally when patients stop to thank us for taking care of them.

A study of nurses demonstrated the intrinsic value of sharing appreciation for staff members on a routine basis. The study authors found that expressing appreciation promoted “higher job satisfaction, fewer illnesses, and more proactive behavior.”4 Incorporating expressions of gratitude into your practice and recognizing work, whether through awards, office outings, or even a handwritten thank you note from the physician can create a healthy culture and inspire your staff.


Defining goals, understanding the mission of the practice, and setting appropriate expectations for staff members also help to encourage an amicable work atmosphere. Employees value being part of a work community that exists for a greater purpose. Practices thrive when team members have an understanding of the meaning behind their work and how their individual efforts affect the goals of the practice.

Moreover, aligning goals with specific responsibilities can help encourage teamwork. For instance, if the goal is to generate more positive online reviews, everyone from the front desk staff to billing personnel should understand what they can do to help achieve this goal. Rewarding the achievement of this goal with an appropriate incentive will then encourage the entire staff to work together toward it.


To borrow a popular phrase from my favorite baseball team, the Chicago Cubs, top practices blossom when they have a culture that encourages “everybody in.” This Cubs marketing campaign has largely been successful not because it sells a specific brand, but rather because it focuses on the emotion of inclusivity.

Similarly, everyone on the practice staff should feel that he or she is a valuable member of the team whose input is respected. Depending on the size of the practice, conveying this message is a duty that typically falls on the office manager. But, to elevate a practice to the next level, the ophthalmologist can take steps to show that he or she personally recognizes the value of each individual on the team.

For instance, you can seek input from staff members when making decisions for the practice and provide opportunities to allow even the quietest staff members to come speak with you directly to offer feedback. Engaged employees may notice something from the patient or staff perspective that is not apparent to you and offer valuable feedback.


Finally, to grow a positive culture, there must be rules and policies in place that make sense. Assuming you have hired the right staff that fits your culture in the first place, a structure should be present to support the mission and goals of the practice without stifling flexibility and common sense. The rules will vary from practice to practice, but, in general, they should be applied evenly to all employees and should encourage good behavior. Ultimately, the office should be a comfortable place your employees look forward to coming to each day.


Building a powerful, meaningful, inspirational culture enhances patient care and improves practice efficiency. By employing the principles behind being a LEADER, ophthalmologists can create an outstanding patient-centered practice that also boasts a positive, healthy work environment.

1. Goffee R, Jones G. Creating the best workplace on Earth. Harvard Business Review. May 2013. https://hbr.org/2013/05/creating-the-best-workplace-on-earth. Accessed September 5, 2019.

2. Bhullar N, Surman G, Schutte NS. Dispositional gratitude mediates the relationship between a past-positive temporal frame and well-being. Personality and Individual Differences. 2015;76:52-55.

3. Burton LR. The neuroscience of gratitude. Wharton Health Care Management Alumni Association. www.whartonhealthcare.org/the_neuroscience_of_gratitude. Accessed September 6, 2019.

4. Burke RJ, Ng ESW, Fiksenbaum L. Virtues, work satisfactions and psychological wellbeing among nurses. Int J Workplace Health Manage. 2009;2(3):202-219.

Lisa M. Nijm, MD, JD
  • Founder and Medical Director, Warrenville EyeCare & LASIK, Warrenville, Illinois
  • Assistant Clinical Professor of Ophthalmology, University of Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, Chicago
  • LMNijm@uic.edu; Twitter  @LisaNijmMDJD
  • Financial disclosure: None