EyeTools Optometry Skills

280: Aggregation of marginal gains

I want to make sure my practice is the best and most prosperous in my area. I want to be better than the competition. Do you have any tips?

I am a believer in the aggregation of marginal gains.

This is where everything involved in a process is broken down into small elements and then an attempt is made to improve each element by 1%, with a significant aggregated increase in performance following these marginal gains. It has been used in competitive cycling and some types of business.

It is a process-improvement technique. It is about thinking small, not big. Supporters of this technique say ‘forget about perfection; focus on progression, and compound the improvements.’ Continuous improvement comes through the aggregation of marginal gains.

You could adopt this philosophy for your practice by searching for a tiny margin of improvement in everything you do.

Here are some elements of eye care practice you could look at:

What is involved in a patient coming to your practice?

Contact the practice in person or via phone to make an appointment

Be greeted at the appointment, waiting area, and waiting time

Being greeted by an eye specialist

Consulting room and equipment


Hand over

Frame selection

Lens selection


Contact for collection




You could break some of these processes down further into smaller elements and then think about how these elements could be improved by 1%. Perhaps the phone could be answered more quickly, or the patient greeting more friendly, the practice a little bit cleaner, the consulting room a bit tidier, the examination a bit more accurate, frame selection more attentive, payment more friendly, and so on.

Other areas where marginal gains can be sought are negotiating frame and lens prices. Try and get an extra 1% discount over and above your normal discount. What about raising prices by 1%? Try and get a reduction in rent by 1% or the electricity bill by 1%.

If each element is improved by 1% think of the massive gains. You will get a significant increase when you put them all together.

By using the aggregation of marginal gains your patients and staff will be happier and your practice will be more prosperous.


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