Proof positive: reinventing a practice through evidence

Successfully applying for Government innovation funding has allowed BBR Optometry to take a methodical, data-driven approach to questions that arise during day-to-day practice.

In 2010, after struggling to recruit an optometrist, BBR Optometry owner, Nick Rumney (pictured below), worked with Aston University academic, Dr Shehzad Naroo, to secure a grant that allowed him to host a researcher at his Hereford practice.

Mr Rumney emphasised that Innovate UK Knowledge Transfer Partnership (KTP) was previously largely uncharted territory for optometric organisations, with most applications coming from companies working within the manufacturing industry.

Dr Neelam Patel undertook her doctoral research at BBR Optometry. She spent three days a week completing research in an office within the practice and two days a week delivering extended clinical services, allowing her to collect real-world data.

BBR Optometry contributed £60,000 funding over three years, while Innovate UK invested £120,000 in the scheme over the period.

Mr Rumney highlighted that the business’ contribution was little more than what they would pay for a part-time optometrist working in the practice two days per week.

Increasing clinical focus

The project has resulted in BBR Optometry making substantial changes to its business model.

The practice now has 25% of patients on a monthly payment plan, and has also shifted the proportion of its income towards clinical rather than retail services.

“Of all the income coming into the practice, 50% of it is coming from the sale of chair time, not the sale of product,” Mr Rumney shared.

He highlighted that this shift in direction was important for the business at a time when the future of retailing in optics looks increasingly uncertain.

“It effectively means that in terms of the ‘nuclear’ option where everything goes online and nobody is dispensing, we will still have an income stream from examinations,” he explained.

"You need to measure, of course, but you also need to use that information to make a change"

Guessing game

While the growth of extended optometric services is gathering pace, it can be difficult for optometrists to judge how these services can be incorporated into a sustainable business model.

He emphasised that before undertaking the project, setting prices for goods and services was often a matter of calculated guesswork.

“In days when the profession was relatively cash rich with people walking through the door, maybe that wasn’t so much of a problem, but now you need to know you can make a return,” he shared.

Mr Rumney highlighted that, to his knowledge, there are few enhanced optical service schemes with fees set on the basis of research conducted in-practice.

Data derived from the project identified who was the most appropriate staff member to undertake tests and how long the test should take to maximise profitability of established schemes.

One of the projects undertaken as part of the research was analysing the effect of a 20% increase in examination fees.

The practice found that the change did not result in a drop off in patients, Mr Rumney highlighted.

“Every optometrist up and down the country has this mental picture that if they put their fees up people aren’t going to come and see them,” he shared.

“That is simply incorrect. The public does not behave like that,” Mr Rumney added.

Research examining the impact of implementing a monthly pay plan showed significant benefits for the practice.

The scheme sees patients pay a set amount per month and receive a discount of 30% on the cost of new glasses.

They also receive a premium examination service and a 50% discount on the cost of repairing damaged spectacles.

Mr Rumney highlighted that the monthly payment plan has now been taken up by one in four patients within the practice.

The initiative has evened out the peaks and troughs in examination attendance, while also decreasing the likelihood that a patient will switch to another practice.

“There is a huge amount of inertia,” he shared.

“It is similar to the experience of banks, utility companies and mobile phone companies – something major will have to go wrong before a customer starts to walk,” Mr Rumney observed.

Dr Patel also examined the cost-effectiveness of three new services as part of the project – OrthoK, an Optos ultra-widefield scanner and a dry eye management clinic.

A step ahead

Dr Naroo told OT that there is an increasing awareness of the need to base emerging clinical services in research.

“People are talking about evidence from practice-based research already and the shared care model is beginning to be debated in the public arena,” he observed.

“I think we are a couple of steps ahead because we know how to prove there is a demand, we know how to cost it and how to deliver it,” Dr Naroo shared.

Dr Naroo elaborated that the approach taken at BBR can be used across a range of different areas of practice.

“It translates across different services so it’s not confined to dry eye management or OrthoK. You can say, ‘What is going to be the next big thing in optometric practice?’,” he shared.

A researcher can then examine any questions that a practitioner might have about an up-and-coming product or service, and use this analysis to make adaptations in practice.

This is an area that BBR Optometry is particularly strong in, Dr Naroo highlighted.

“You need to measure, of course, but you also need to use that information to make a change. That is something that BBR wasn’t afraid to do,” he added.

The research undertaken through the scheme was also valuable to Aston University, he observed. 

“As an academic it is a great partnership for me as I can see the direct impact of my research in clinical practice,” Dr Naroo shared. 
“We want information from people like Nick. Neelam was sending through Excel spreadsheets, which is what we live on,” he elaborated. 

Diverse benefits 

Dr Naroo concluded that the initiative was a “win all around” for the practice, the researchers involved and the university. 
He noted that while the average practitioner may be hesitant about the impact of measurement, there are many researchers across the UK who are willing to help out.

“I would say to any local optometry practice, if you are interested in doing this, speak to your local university or optometry school, and there will be someone with an interest in what you have got to say,” he shared.

Those interested in finding out more information about the scheme can contact Dr Naroo by emailing [email protected].