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When more isn't better

Kasewurm, Gyl A.

doi: 10.1097/01.HJ.0000360854.94701.f7
Gyl's Guide to Managing for Success

Gyl A. Kasewurm, AuD, is Founder, President, and Owner of Professional Hearing Services in St. Joseph, MI, which receives more than 16,000 patient visits a year. Readers may contact Dr. Kasewurm at For past installments of Gyl's Guide, visit the HJ archives at



I was chatting with a colleague recently who confided in me that she was struggling with her business. The staff's schedules were full and everyone seemed to have more work to do than time to do it. Yet, despite all the activity, profitability was declining. She was investigating ways to attract new patients, and contemplating adding more staff to handle the increased workload. If all else failed, this frustrated business owner was convinced that opening an additional location would solve her problems.

As our discussion continued, it became obvious that she was convinced that more patients were the answer to her problems. This made me wonder,

“When is more not better?”

Initial answers that came to mind included: more weight when your stomach already hangs over your belt, more beers if you have already had one too many, more men if you're already married to one. As my mind shifted from the amusing to the more serious topic of business, a few other examples in which more is too many came to mind:

More patients if you are seeing them for free. Patients who come for free screenings or free trials and never purchase anything are not adding to the bottom line of a business. Lots of people will say “yes” to something that is advertised as free but how many of them really want to improve their hearing?

It's unfortunate, but many patients are not really committed unless they have something invested. When considering whether or not to do anything for nothing, remember that time is money and any time invested in someone who really isn't interested in improving their hearing costs the business money.

More employees if they aren't contributing to the bottom line. If a business is growing, it will reach a point when the owner can no longer manage all the required tasks. If you can no longer serve patient needs in a timely manner, it may be time to think about adding an employee. If patients are leaving empty-handed or going to your competitor because you are too busy to see them, then it's time to do something.

At this point, the real question is what type of staff will best serve your business needs: professional or support staff. Never add staff simply because an employee complains of being too busy. An employee's activity level may not be a reflection of their value to the business.

In most organizations, employees represent not only their main asset but also their largest investment. Using that investment to ensure productivity is fundamental. While every employee should be treated with respect, setting realistic goals and objectives for them is necessary to maintain their focus and value to a business. Business changes and policies and procedures must reflect those changes. Therefore, employers should periodically assess employee performance to insure that current procedures reflect the present needs of the business.

More locations if they aren't growing the business. Growth and expansion require careful planning. The decision must be a result of thoughtful consideration of various factors, including financial, logistical, practical, and even the owner's emotional readiness.

According to the Small Business Association, the rule of thumb is that a business should expand only when there are untapped opportunities that can benefit the business. Expanding operations does not always mean more profit. The fact is a business may be doing more volume by adding a second or third location and the owner will definitely be working harder. But with additional overhead, profitability may not improve and may even decline during the initial phase of expansion.

It's not a good idea to open another location as a reaction to what your competition is doing. If, however, another practice is expanding and taking business away from you because of that expansion, you should at least evaluate the results of adding another location. Growth isn't for everyone. Some practice owners are content operating a single location and being the sole service provider; others may want to create a Microsoft of hearing healthcare organizations. The annual survey of this publication indicates that the typical hearing healthcare practice has a single location and just one service provider. If run properly, this type of practice can produce a very respectable income for the owner.

Perhaps the solution to a struggling practice lies not in having more patients but in doing a better job with the patients you have and making sure to maintain contact with them and to perform routine assessments of aided performance insuring that every opportunity is taken to help patients have the best hearing possible.

So, when is more better? Only you can determine what is right for your business.

The only time I'm sure whether or not more is better is when it comes to shoes. In that case, more is definitely better!

© 2009 Lippincott Williams & Wilkins, Inc.