Understanding Decision-Making in Optometry: Hats, Haircuts and Tattoos

I was recently listening to Adam Cmejla’s “20/20 Money” podcast episode with guest Steve Vargo, and they discussed measuring practice success. They also talked about approaches to making changes in your practice to build the practice you want and brought up the book “Atomic Habits” by James Clear. What they discussed was how he uses the analogy “hats, haircuts and tattoos” to categorize decisions based on their reversibility.

Understanding the Analogy

What does this mean exactly? There are different types of decisions we can make, and by figuring out which category they fit into, we can either take a risk or put it on the back burner until we have more research.

Most of our decisions are like hats—you can try one, and if you don’t like it, you can put it back and try another. Haircut decisions are a little different. You can fix a bad one, but it won’t be as quick, and you may feel foolish for a while.

Clear stresses that while it may take some time, don’t be afraid to make a haircut decision. If it doesn’t work out, in a year you will have moved on, and so will everyone else. Tattoo decisions are the most permanent—once you make the decision, you have to live with it. Some of these decisions are even irreversible. The decision can leave a lasting impact, and you will have little opportunity to fix and correct it—so think long and hard!

Examples of Decisions in Practice

What are some hat, haircut and tattoo examples in our practices? Which category do most of our decisions fall into? And do we tend to catastrophize and think most of our decisions are tattoos when really they are hats and haircuts?

Any practice owner is faced with a multitude of decisions daily, and as a cold start owner, I feel like this was amplified. It can often feel scary to make a decision because we feel a permanence and can often experience decision paralysis. What if I make the wrong decision? How can I bounce back from it?

The Importance of Research

The first step (that is often skipped) in making decisions happens before you pull the trigger. It is so important to do careful research and a cost-benefit analysis to ensure the decision is one that makes sense for a practice. Once the decision is made, business owners have to continue to track metrics, readjust and be honest if they need to change course.

Hat Decisions: Quick Changes

When I think about “hat decisions” in a practice, I think about small changes we can make that can be quickly changed if they fall flat. What are some examples? Raising fees and prices! We are often so hesitant to raise the prices in our offices, and as a small business owner, this is essential to ensure profitability.

Likely, your vendors have raised their fees and prices over the last six to 12 months, and if you haven’t followed suit, you are already losing money. How much is too much? Only you know that for certain. But changing pricing is a truly haircut decision, and one that can be modified quickly (and should be done often!).

Haircut Decisions: Promotions and Staffing

Another haircut decision is running a promotion or sale. We are always looking for creative ways to increase revenue and sales and have tried some different types of promotions in our optical studio. Having an in-office lab allows us to be more flexible on pricing and offer frame and lens packages to stay competitive. If we found these weren’t working or decided to stop? Just like swapping out a hat, we can quickly change gears!

I think most of our decisions in our practices fall into the haircut category. They aren’t as easily changed as a hat, but they don’t have the true permanence of a tattoo (although they may feel that way in the moment!).

One big one that comes to mind is staffing. Making changes in our team can often feel permanent, but in the grand scheme of things, they really are less impactful than that. We have all had to make the tough decision to part ways with an employee who is not right for the team, and in the moment, we may panic that we will be short-staffed or that patients may miss them. When we look back a year later, we realize that it wasn’t as big of a deal as we thought—same as if we had a bad haircut. Everyone moves on!

Navigating Significant Decisions

Another haircut decision that comes to mind is changing EHR/practice management systems. It is definitely a significant decision that we shouldn’t make lightly, but it is not as permanent as we think. Adding or selling off a frame line, bringing on a new piece of equipment, adding a specialty, or bringing on an associate, are also examples of haircuts in our practices. We should be doing our due diligence before we make the decisions, but there is always a “way out” if necessary (although it may take some time and guidance).

I also think of haircut decisions in different ways—we can have a bad haircut that we just need to wait some for it to grow out, or a more risky decision like a perm or color that needs more time and professional help to fix. I’d include opening a cold start, opening a satellite location, doing an office expansion or renovation, purchasing or selling a practice, buying real estate, or moving to a new location to start a job, in this category.

These decisions may seem permanent and irreversible, but with professional guidance and time, they can be remedied. Just like making sure we are ready to commit to bangs or a new shorter haircut, we need to ensure we are ready to take the next step in these scenarios.

Tattoo Decisions: Are They Really Permanent?

What would qualify as a tattoo decision in an optometric practice? I really can’t think of any! With proper guidance and advice, we can usually navigate through the decisions we make in our practices, whether they be hats or haircuts. They may feel scary and permanent, but with careful planning and risk analysis, we can actually see that many of these decisions are worth the risk and are ones we should be taking in our practices to increase profitability and efficiency.

I have even started labeling these choices in my head as “hat, haircut or tattoo,” so I can quickly figure out how much time and energy need to be allocated to them. Even better, you can use these in your personal and family life too!