Premium IOL adoption shouldn't depend on who is in the consultation room.

Illustrative stock photograph, not a PDDA® client team. Photo: Tima Miroshnichenko / Pexels.

Your strongest counsellor is away. What changes?

Consider a hypothetical Monday. Same clinic. Same lenses. Same appointment book. But the colleague who normally spots the unanswered question, repairs a confused explanation and makes sure the surgeon gets the right information is on holiday.

The clinic has not lost a piece of equipment. It has lost a piece of its operating system—because that system lived inside one person's head.

That is the problem behind the headline. Not that people do not matter. They matter enough that their best work should not disappear when they leave the room.

Same process does not mean the same decision

Different patients should make different choices. Clinical suitability, visual priorities, affordability and willingness to accept trade-offs all matter. Two surgeons can have different premium-IOL adoption rates without either doing anything wrong.

A consistent pathway does not mean an identical premium percentage. It means that the important parts of decision support do not happen by luck: understanding the patient's priorities, discussing appropriate options and limitations, identifying the unresolved question, and agreeing what happens next.

The decision stays personal. The support around it should be dependable.

Your best person may be doing work nobody has named

Before buying another training session, look at what an experienced colleague actually does. Not just the words they use.

Do they notice when a polite “yes” does not mean understanding? Do they pause when the patient mentions driving at night? Do they carry a concern into the handoff instead of expecting the patient to repeat it? Do they know when to stop explaining and bring the clinician back in?

These are things to investigate in your own clinic, not assumptions about every team. The useful question is: which actions support the decision, and which of them exist only as personal habits?

“She is brilliant with patients” may be true. It is not an implementation plan.

Copy the function. Not the personality.

You cannot turn every colleague into your most charismatic counsellor. Nor should you try. What you can do is make the useful work visible and teachable.

Take an illustrative situation: the patient says that night driving matters, but an unresolved concern about visual disturbances is left in a free-text note that the next person does not see. The team has collected information without ensuring that it reaches the clinical conversation.

The fix is not automatically a longer questionnaire. Agree five things:

• Trigger: what information or uncertainty requires a handoff?
• Action: what must happen before the decision moves forward?
• Owner: who makes sure it happens?
• Location: where will the next person actually see it?
• Exception: when should the team pause and ask the clinician?

In this example, the priority and unresolved concern need to reach the clinician, who assesses the relevant options and limitations. The coordinator is not being asked to prescribe a lens. They are being asked to make an important piece of the conversation hard to lose.

The exact wording can vary. The responsibility should not.

Can another trained colleague pick up the thread?

Here is a practical check. Using an appropriately authorised, de-identified example, ask a trained colleague to find the patient's priority, the relevant clinical assessment, the unresolved question and the next agreed step in the ordinary record.

Can they continue within their role without calling the person who handled the previous conversation? If not, where does the handoff fail?

This is a workflow exercise, not a validated clinical test. Do not remove needed supervision or patient support to run it. You are checking whether the pathway carries information—not whether a colleague can improvise under pressure.

You may find that the required information was never captured. Or that it was captured twice, buried in two places and read by nobody. Those findings call for different changes.

Make it work on a busy day

A new document is not the same thing as a new habit. Design the change with the people who will use it.

Put the prompt where the work already happens. Remove a duplicate step if you can. Rehearse a difficult example. Name the person who will review actual use. Ask the team where the change creates extra work—and fix that before rolling it out.

The benefit to the team should be concrete: fewer situations in which somebody must reconstruct the previous conversation or rescue a missing handoff. Whether the change actually saves time needs to be measured, not announced.

Start with one weak transition. You do not need to redesign the entire clinic before learning whether that change is useful.

Measure the process before crediting the result

First check whether the intended action happened. Did the concern reach the right person? Was it addressed? Could another colleague identify the next step?

Then look at time, repeat explanations and decision outcomes separately. Define what you mean by adoption: options discussed, patient acceptance, procedures booked and lenses implanted are not interchangeable numbers.

If a commercial result changes, check what else changed—patient mix, prices, referral sources, staffing or clinical practice. A before-and-after difference is a reason to investigate, not automatic proof that your new process caused it.

For a brand, the same question becomes a scale question

A pilot can look promising because one exceptional clinician or coordinator makes it work. Before taking it to another clinic, ask what the team actually needs to reproduce.

Which actions are essential? What needs local adaptation? Who will own implementation? What evidence would show that the next site is using the approach, rather than merely attending the training?

Your best clinic can teach you a great deal. It is not, by itself, your rollout plan.

What PDDA® is there to do

In a PDDA® programme, this is a practical implementation question: how do we turn useful individual expertise into a pathway the team can operate?

The work can connect the expectations created before the visit, the consultation itself, handoffs and follow-up. The output is not a demand for everyone to sound the same. It is a working sequence, clear responsibilities, usable tools and a way to review what changed.

Strong clinicians should have room for judgement. Strong counsellors should have room for personality. Neither should have to carry an invisible system alone.

If your premium-IOL pathway works only when your strongest person is present, start there. Find out what they are holding together—and make that work transferable.

Discuss your clinic's premium pathway or explore IOL brand advisory.