In the restaurant business, the difference between being good and being excellent is huge. Very few restaurants make it into the top tier, and few are able to stay there. A recent experience I had at a restaurant gave me some insights into how successful restaurants manage for excellence. More pointedly, these lessons can be very easily applied to achieving excellence and success in dermatology practice.

Chris’ Café in Santa Fe, New Mexico has been rated on TripAdvisor as one of the top 10 restaurants in town for at least two years. Interestingly, it isn’t one of the chic spots that typically garner accolades. It is instead a breakfast joint that serves huevos rancheros, pancakes, and hash browns along with five-alarm green and red chili. During a recent visit there, I had the chance to talk with the owner, Chris Valdez, about his business and how he continues to excel.

As usual, he was on the floor working the restaurant, clearing dishes, cooking if needed, and chatting up the customers. He told me that he doesn’t leave the restaurant often and, when he does, he expects he will have to correct his staff and reassert his vision of how he wants things done. He related that when he hires a new cook, even though he has specific recipes and instructions for the staff, he expects that without constant intervention the food will change to the new cook’s preferences within a week or two unless he rides herd. In short, he practices process control, but never expects it to remain under control. It’s what it takes to be top of his game.

The same rules apply to our practices, especially if we want to be in the cosmetic arena. In order to keep our customers and patients happy, we have to analyze and itemize nearly everything we do—including all potential patient interactions—so that we can train new (and even existing) staff in the way we wish that to happen.

Processes ranging from answering the phone (Do we answer with or without the name of the staff member?) to the good-bye salutation (Do we say “Bye” or “Thank you, Mrs. XXX for coming to see Dr. Schlessinger!”) are essential to success and should be standardized. This is only the beginning, however.

There are myriad other ways to finesse your practice, from whether to offer a survey (and then how to respond to the results) to what the staff should wear and how they should refer to you or the patients. Each one of these situations and decisions can lead to success or mediocrity while defining the character of your operation. But the most important thing that Chris taught me about what I do is that having processes in place (including a handbook that could take hours, even weeks to prepare) isn’t enough—you have to enforce and manage the processes and expect that it won’t stay the way you want it.

Staying on track and enforcing processes may seem easy to us, particularly with our backgrounds in medicine that teach us a standard approach and the virtues of adherence to regimens. However, not all staff members may see it that way; for example, millennials (and GenX-ers, etc.) have more of a tendency toward individualism, and that means more “interpretation” of rules and less compromise for the good of all. This edition of Practical Dermatology® magazine features articles that address these very issues, from constructing and using patient surveys to understanding the millennial mindset.

The take-home message here is that change will happen and that change may not be conducive to delivering care the way you may always expect it to be done. Expect that things will change and don’t be surprised when methods for collecting insurance copays aren’t observed or scheduled slots are filled incorrectly. Look for these deviations in standards and quickly assert yourself if you feel they should go back to the initial way they were done. Without constant attention and supervision, chaos happens. Most importantly, when things do change and your hard work is undone, take a breather and smile, knowing that you are not alone in the struggle to keep everything in order.

We all know the difference between a good and bad restaurant experience, and the same can be said for our services as well. It isn’t easy to do this, but with careful attention to how we deliver services, we can better ourselves and provide a superior experience for our end-users. n

—Joel Schlessinger, MD

Chief Cosmetic Surgery Editor