Becoming the Captain: Leadership Lessons for Small Practices

Leadership doesn’t wait for a grand stage—it reveals itself in the daily hustle of a small practice. Between patient exams, billing paperwork piling up and phones ringing off the hook, sudden challenges—a staff illness, an equipment breakdown, an overflowing waiting room—can strike at any moment.

Without someone steering the ship, chaos is all but guaranteed. It’s in those ordinary yet critical moments that leadership shifts from theory to necessity: someone must maintain composure, clarify priorities and guide the team toward a shared goal.

Defining Leadership: More Than a Title

To me, leadership has always been about direction. The word itself implies leading, but what are you leading people toward? It isn’t enough to simply stand in front of your team and issue commands. Leadership means crafting a clear vision, recruiting people who share that vision and guiding them toward it—together.

When I wrote my book, “Eye on Leadership,” I broke this down into three pillars: vision, recruitment and guidance. A leader asks, “Where are we going?” before worrying about “How fast can we get there?”

Why Every Small Practice Needs Leadership

Every team needs a leader to unite efforts and accomplish a shared goal. Even in a practice with just three employees, leadership is essential to prevent the myriad problems I’ve seen where a leadership void exists. Small teams can manage fairly well without a formal leader, but only until stress hits. Without clear expectations and accountability, disputes over roles can fester. Underperformers slip through the cracks. Growth stalls.

A small practice without a leader is like a ship without a captain: calm seas are fine, but storms will come—and without someone at the helm, the crew will panic. Solid leadership prevents those storms from capsizing your practice.

Day-to-Day Tactics

On a practical level, leadership in a small practice means:

• Setting clear expectations: Every team member knows exactly what success looks like in their role.
• Empowering ideas: Hold weekly meetings for idea sharing, and keep an open-door policy so staff always feel welcome to offer suggestions.
• Ongoing coaching: Rather than waiting for annual reviews, give feedback in real time.
• Accountability for all: If the schedule slips or a billing error occurs, dig in together. As a leader, don’t exempt yourself—it works both ways.

Vision vs. Grandiosity: What You Really Need

You don’t have to be the next Steve Jobs to lead a thriving practice. You do, however, need clarity. Think like a CEO: have a clear understanding of what you’re building and why it matters. Be intentional about the culture you want, the patient experience you deliver and the growth you pursue. Communicate this vision daily—on the phone, in your team meetings, even in casual hallway conversations. Over time, repetition turns vision into shared purpose.

There are two qualities I find indispensable in every successful leader: a healthy balance of assertiveness and humility. Assertiveness equips you to have tough conversations—giving candid feedback, holding people accountable and making decisions that aren’t always comfortable. However, humility keeps you coachable—inviting feedback, admitting when you’re wrong and listening to ideas. Without humility, you’re not a leader—you’re merely issuing orders.

Leadership isn’t just about processes—it’s about people. Empathy is at the core of emotional intelligence. Do you genuinely care about your team’s well-being? Do you listen to their ideas and concerns? Strong leadership drives practice growth, but achieving it requires respecting the team members who make it possible.

I recently consulted with an optometrist who hosts an annual staff retreat filled with team-building exercises and nonclinical activities. That “vulnerable time” fosters trust and rapport, enabling her to understand her staff better—professionally and personally. These relationships pay dividends in engagement and loyalty.

Calculated Risk-Taking

All businesses face risk. One example in eye care is dropping insurance plans. That’s a calculated risk if you have a strategy—perhaps by offering specialty services or crafting a communication plan to retain out-of-network patients. A reckless risk would be flipping the switch without any plan to offset lost revenue or retain patients. Good leaders weigh pros and cons, prepare contingencies and move forward with confidence.

Mentorship: No Leader Does It Alone

We all need mentors. They broaden our perspective and keep us accountable for our own development. Today, you can find books, podcasts and online communities dedicated to leadership. Beyond that, connect with other business owners inside and outside eye care. I’ve learned as much from a local coffee shop owner about customer experience as I have from fellow optometrists.

Here are a few of my favorites for practice owners looking to deepen their leadership skills:

• “Who Not How” by Dan Sullivan
• “The Five Dysfunctions of a Team” by Patrick Lencioni
• “The Best Place to Work” by Ron Friedman, PhD
• “Drive” by Daniel Pink
• “Influence” by Robert Cialdini, PhD

And, of course, my own book, “Eye on Leadership,” written specifically for eye care professionals.

As a Leader, Learning Never Ends

No single “correct” leadership style exists. The most effective leaders remain students, adapting their approach as their team and challenges evolve. After every initiative, ask yourself: Did our staff respond well? Did outcomes improve? If not, it’s not failure—it’s information. Use what you learn to refine your approach. Over time, you’ll build a leadership style uniquely suited to your practice.

A small practice succeeds not because of a single person, but because everyone shares a clear vision and the confidence that, together, they can weather any storm. That’s the true power of leadership.

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