The Promise of Time: The Ultimate Customer Value Proposition | What’s Your Edge?

Today’s conversation explores how a lean process improvement initiative, originally launched to address patient complaints about long wait times, evolved into something much more: a deeply embedded customer-centric culture grounded in customer value and customer-centricy, and a move away from random acts of efficiency toward a systematic, measurable approach to customer experience. Stephanie Collins, CEO of Austin Retina, a practice that has been serving patients since 1979, joins us today as our guest for What’s Your Edge.  Stephanie has been with the organization for 25 years, rising through the ranks to lead the practice through significant growth. The practice has grown from a single provider to 19 physicians and nearly 300 employees. And recently, it became a part of Cencora, a global leader in pharmaceutical and medical supply distribution. Stephanie, I’m looking forward to learning how Austin Retina reframed time as a critical dimension of value, how you operationalized customer-centricity, and how you measure the impact of customer value on growth, loyalty, and performance.

Stephanie, welcome to the show.

Stephanie, let’s start with the moment that really catalyzed change. In 2015, Austin Retina initiated a lean process. One of the primary triggers was patient feedback that they felt the practice didn’t value their time—that they were being treated like a number. I imagine most everyone listening has experienced this feeling. In fact, nationally, studies suggest that patients spend roughly 11–18 minutes just waiting to be seen in a doctor’s office, and when you add travel and disruption to the workday, researchers estimate about $89 billion a year in lost time due to medical visits. Now, when we wind back the clock, patients were often in the office for three hours, and these patients often see their physicians every 4–6 weeks. That is a significant time commitment. We can easily see why the initial goal of the lean initiative was straightforward: shorten wait time. Congratulations on achieving your goal and reducing the wait time from three hours to about 90 minutes. Take us back to that period. What were you hearing from patients that made you realize “we have to do something different”? Was there a specific story or piece of feedback that made the leadership team say, “We cannot continue this way”?

When I think back to that time, what really struck me wasn’t just that patients were waiting a long time — it was how that wait made them feel. We began hearing consistent feedback that patients felt like they were being processed rather than cared for. One moment that stuck with me came from a long-time patient who very kindly said, “I know you’re all working hard, but it feels like my time doesn’t matter.”

For a patient who is already managing a chronic condition, that comment was eye-opening. Many of our patients visit us every four to six weeks, and for many years. When they’re spending three hours in our office each time, it adds up to a tremendous burden.

That was the moment when our leadership team realized this wasn’t just about efficiency — it was about respect, empathy, and dignity. We couldn’t continue operating in a way that unintentionally signaled that our time mattered more than theirs. That realization is what pushed us to take bold action and pursue a lean initiative.

I personally believe time is our most precious asset. How did you and your team come to frame the problem—not just as an operational issue, but as a patient or customer value issue?

As we started digging into the long visit times, we realized the real question wasn’t just “How do we make the process faster?” — it was “Are we delivering what patients truly value?” That shift in thinking was important. We wanted to reduce waste, costs, and redundancies in the process, but never at the expense of the quality of their care or the relationship they have with their physician.

Framing the problem through the lens of patient value helped us focus on improving flow and eliminating waste while still protecting the elements of care that matter most. It allowed us to design improvements that were more meaningful, more patient-centered, and ultimately more sustainable.

I love the fact you stepped into your customers shoes.  In our work, we define customer value as the balance between what customers receive and what they must give up, such as time, effort, money, and risk, to obtain that value. For many customers, time is one of the most precious currencies.  From your perspective, when did you begin to see time not just as a scheduling issue, but as a core component of the value proposition Austin Retina offers its patients?

The turning point for me was recognizing that time is deeply emotional. It’s tied to autonomy, to a sense of control, to quality of life. In retina care, many of our patients already feel like they’ve lost control — their vision, their health, their schedule revolves around injections and follow-ups.

So, when we began mapping the patient journey, we realized that if we could give time back to them, we were restoring some of that control. That’s when it became clear that time wasn’t a scheduling matter; it was a core part of our value proposition.

You started with a lean initiative to reduce wait times, but over time, that effort evolved into something deeper—a cultural shift toward patient or what we call customer-centricity. At what point did you recognize, “This is no longer just a process improvement project; this is reshaping our culture”?

For us, the moment we realized this had grown beyond a process-improvement initiative and had truly become a cultural transformation was when patients started commenting on their own. We began hearing things like, “I don’t know what you’re doing differently, but keep it up!”

Those spontaneous comments were incredibly validating. They showed us that patients weren’t just experiencing a shorter visit — they were feeling a real improvement in how they were cared for.

What was just as meaningful, though, was what happened internally. As patients started noticing the changes, our staff re-engaged in a way we hadn’t seen in a long time. They began bringing forward new ideas, suggesting areas where we could streamline or improve the experience for everyone. You could feel the excitement building — this sense that we were accomplishing something important together.

That combination of patient appreciation and staff enthusiasm is when we knew we weren’t simply adjusting workflows. We were reshaping our culture around valuing time, reducing frustration, and creating a better experience across the board.

What an excellent point about how the process helped reshape the culture. We often talk about the need to operationalize customer-centricity; that is, to move from slogans about being customer-focused to embedding customer value into processes, metrics, and decision-making. What were some of the concrete operational changes that signaled to your patients, “We heard you, and we’re changing how we work to respect your time”? And how did you make those changes stick so they became “the way we do things here” rather than a one-time initiative?

Some of the most meaningful changes were:

• Standardized rooming and diagnostic workflowsto eliminate unnecessary steps.
• Reviewing patient flow dashboards and metricsso staff could anticipate bottlenecks and improve processes to keep them from happening.
• Cross-training team members, which gave us more flexibility to keep patients moving smoothly.
• Redesigning the appointment templateso it accurately reflected the true time needed for different visit types.
• Physician huddles every morningto align on the day’s flow.

What made these changes stick was that we embedded them into daily management. They weren’t “projects”; they became expectations. And as soon as patients started noticing shorter visits and smoother experiences, the team became even more committed.

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I think that’s a powerful point about making changes expectations. We often emphasize that customer-centric growth depends on being able to define, measure, and monitor customer value. We’ve written about customer value metrics that facilitate customer-centric growth and about the importance of identifying the variables that matter most to your customers, like time, access, outcomes, relationship, and so on: What measures and metrics are you using to track whether you are delivering that value? For example, do you track average total visit time, wait time by stage, on-time starts, or visit variability? And have you adopted or adapted any form of customer value metrics beyond the measure of time, such as combining time, satisfaction, and clinical outcomes into a composite view of value?

To truly understand whether we’re delivering value, we had to measure the elements of the visit that matter most to patients. Today, we focus on a set of operational and experience metrics that give us a clear picture of both efficiency and patient perception.

We measure:

• Total visit time, or what we call “lead time,” from check-in to check-out.
• Wait time by task, so we can identify precisely where delays occur.
• Total task time, which helps us understand how long each component of the visit actually takes.
• Throughput by clinic and by physician, to monitor balance, capacity, and flow across the organization.
• And importantly, patient satisfaction scores, which allow us to connect operational performance with how patients actually feel about their experience.

By looking at these measures together, we’re able to evaluate not just speed, but predictability, consistency, and overall patient value. It helps us pinpoint where improvements will make the greatest difference in the patient experience.

Stephanie, these seem like meaningful measures. Thank you for sharing them. We strongly believe that customer value delivers faster organic growth. And that organizations that explicitly manage and measure customer value tend to grow faster and more profitably. Stephanie, how has focusing on patient value, particularly time, influenced your organic growth? And have you seen changes in referral patterns, patient retention, or word-of-mouth as a result of this shift?

The shift to shorter, more predictable visits has had a tremendous impact on our growth and our reputation in the community. Patients consistently tell us how much they appreciate not having to spend hours in the clinic, especially given how frequently they need to see us. That positive experience translates directly into word-of-mouth referrals — patients recommending us to family and friends because they genuinely feel cared for and respected.

It’s also strengthened our relationships with referring providers. We hear often that patients go back to their optometrist or primary eye care provider and share how smooth and efficient their visit was. That kind of unsolicited feedback builds trust and reinforces the confidence referring doctors have in sending patients to us.

And operationally, the improvements in flow and visit time have enabled us to care for more patients in the community. When you increase efficiency without compromising quality, you expand access — and that’s incredibly important in a specialty like retina, where timely care can make all the difference.

We often describe the value proposition as the customer-centric bridge between your business and your customers’ definition of value. In a specialty like retina, patients are often with you for a long time, returning every 4–6 weeks. That creates not just a series of visits, but a relationship. In what ways has your value proposition evolved as you’ve become more intentional about being patient-centric?

Consistency is everything. We reinforce our value proposition by making sure patients feel it at every touchpoint:

• Schedulingthat sets clear expectations about visit length
• Front desk teamstrained to welcome patients warmly and keep them informed
• Clinical teamswho explain each step so patients understand what’s happening and why
• Physicianswho focus on empathy as much as expertise

I couldn’t agree more about the importance of every touchpoint in delivering on the value proposition and promise. Stephanie, How do you communicate and reinforce that value proposition, whether that’s respect for time, quality of care, continuity, empathy across your touchpoints (scheduling, front desk, clinical staff, physicians)?

We internally post and discuss metrics with our entire team and celebrate these metrics and the positive feedback we receive on a daily basis.  When patients provide feedback either spontaneously during their visit or via a Google review, we share those highlights with the whole organization thanking them for their commitment.

We’ve written about how relationship strategy and brand equity are strengthened when organizations consistently deliver on what customers value and measure that delivery. Have you seen evidence that your patient-centric approach has enhanced your brand equity, for example, in how referring physicians talk about you, or how patients describe you to others?

Patients consistently mention shorter and smoother visits and feeling genuinely cared for.  When patients begin describing you as “efficient and compassionate,” you know you are doing something right.

It takes commitment to sustain a customer-centric culture and leveraging best practices.  What practices or mechanisms help you maintain alignment around customer centricity?

We use several mechanisms to keep us aligned:

• Daily huddlesfocused on patient flow
• Monthly performance dashboardsaccessible to all teams
• Root-cause reviewsany time our visit times spike
• Patient feedback loops, including direct follow-ups on comments
• A Full time “Patient Experience Manager” focused on training team members about Lean, wastes, customer service, and providing feedback for areas where we can improve.

In terms of process and best practices, I’m curious about how you reinforce your processes. Are there thresholds or targets you manage to—for example, “no patient should be in the clinic longer than X minutes” or “Y% of visits must start within Z minutes of scheduled time”?

Yes, we do track and report on certain metrics and targets for each doctor and their team monthly.  We aim for a 90 min lead time, an efficiency score that looks patients time in clinic compared to the staffing ratio, and of course, always measuring these against patient satisfaction scores and feedback.

Many organizations say they want to be customer-centric, but they struggle to translate that aspiration into metrics, processes, and behaviors. They end up with what we call “random acts”.  Random acts of customer experience, random acts of improvement, random acts of efficiency. As opposed to a disciplined, value-driven approach anchored in customer value metrics. How can leaders avoid “random acts” and instead build a systematic approach to customer value, similar to what you did with lean and patient experience?

One of the biggest lessons we learned is that you don’t have to — and really can’t — build a full systematic approach all at once. That’s where many organizations get stuck. Creating something from scratch can feel daunting, and when you try to design the entire system upfront, it becomes overwhelming and unsustainable.

Lean taught us the value of small, intentional steps. Instead of chasing big, complex solutions, we focused on small-scale trials. We would identify a specific problem, bring the right people together to brainstorm a potential solution, test it on a very small scale, and then track the metrics closely. If it worked, we refined it and expanded it. If it didn’t, we learned quickly and adjusted.

Those small cycles of testing and learning helped us avoid what we call “random acts” — one-off improvements that don’t stick. By taking small steps, guided by data, we were able to build a systematic approach over time. And the team gained confidence because they could see the impact of each incremental improvement. That momentum is what ultimately created sustained cultural change.

In our conversation, I feel like we’ve made the case that customer-centricity is not a project; it’s a way of operating. It requires clarity about what customers value, the right metrics, and a commitment to continuously aligning your processes and decisions with that value. What routines or governance mechanisms help you keep customer value at the center of strategy, operations, and growth?

We have internal hard and soft skill training and onboarding programs, internal certification programs for LEAN and Leadership Development, recognition programs, per physician and team scorecards as well as the leadership team has weekly meetings, and quarterly strategic planning discussions.

Stephanie, thank you for sharing your experience with us.  Based on your journey, what advice would you offer leaders who want to embed customer value—especially time—into their culture and operations and what are some your biggest lessons learned about listening to customers, redesigning processes, and measuring what matters?

My biggest advice is to really listen — and be willing to hear what’s uncomfortable. Patients were telling us the truth long before we acted on it.

Second, don’t underestimate the cultural side of operational change. You can have the best processes in the world, but if your team doesn’t believe in the “why,” they won’t sustain them.

Third, measure what matters. If you believe time is value, then track it relentlessly.

And finally, stay humble. Improvement is never finished. Customer value is a journey; the moment you think you’ve arrived is the moment you start to slip.

Stephanie, your story shows how listening to customers, treating time as a critical dimension of value, and embedding customer-centric practices into processes and metrics can transform both the experience and the business.

For those of you listening, Stephanie’s experience at Austin Retina is a powerful reminder that time is one of the most important forms of customer value. When you make time visible, measure it, and design your processes around it, you move from random acts of customer experience to a disciplined, customer-centric system that improves satisfaction, loyalty, and organic growth.

When you’re ready to move beyond good intentions and truly operationalize customer-centricity in your organization, we’d welcome the opportunity to help you identify practical steps you can take to put time—and customer value—at the center of your strategy, operations, and performance.

(written by Penn of Sintra.ai)

Q1: What is customer value in the context of healthcare and patient experience?
A: Customer value in healthcare is the balance between what patients receive—clinical outcomes, access, reassurance, continuity of care—and what they must give up, including time, effort, money, and risk. In a patient-centric culture, organizations explicitly define what patients value most and design processes, metrics, and decisions to maximize that value.

Q2: Why is time considered a critical dimension of customer value?
A: Time is one of the most important “currencies” of customer value. Long wait times, unpredictable visits, and frequent disruptions erode trust and satisfaction. When organizations measure and manage time—total visit time, wait time by stage, and predictability—they signal respect, improve the experience, and often unlock capacity for faster organic growth.

Q3: How did Austin Retina use lean process improvement to enhance patient experience?
A: Austin Retina launched a lean process improvement initiative in response to patient feedback that visits were too long and patients felt like numbers. By mapping the patient journey, standardizing workflows, cross-training teams, and monitoring flow metrics, they reduced visit times from roughly three hours to about 90 minutes, while preserving quality of care and strengthening relationships.

Q4: What are customer value metrics, and which ones did Austin Retina focus on?
A: Customer value metrics quantify how well an organization delivers what customers value. Austin Retina focuses on measures such as total visit “lead time” from check-in to check-out, wait time by task, total task time, throughput by clinic and physician, and patient satisfaction scores. Looking at these metrics together allows them to evaluate efficiency, predictability, and overall patient value.

Q5: How does customer-centricity differ from traditional efficiency initiatives?
A: Traditional efficiency initiatives often focus solely on internal productivity or cost reduction. Customer-centricity starts with what customers value—such as time, access, and empathy—and then aligns processes, metrics, and behaviors to deliver that value. Lean becomes a vehicle for operationalizing customer-centricity, not an end in itself.

Q6: How can focusing on customer value drive faster organic growth?
A: Organizations that explicitly manage and measure customer value tend to see higher satisfaction, loyalty, and referrals. In Austin Retina’s case, shorter, more predictable visits improved patient experience, strengthened relationships with referring providers, and increased capacity to serve more patients—contributing to faster, more sustainable organic growth.

Q7: What governance and routines help sustain a customer-centric culture?
A: Sustaining a customer-centric culture requires ongoing routines and governance: daily huddles focused on patient flow, monthly performance dashboards, root-cause reviews when metrics slip, structured feedback loops, and dedicated roles such as a patient experience manager. Leadership training, internal certifications, and regular strategic planning keep customer value at the center of decisions.

Q8: How can leaders avoid “random acts” of customer experience and build a systematic approach?
A: Leaders avoid “random acts” by starting with clear definitions of customer value, selecting a focused set of customer value metrics, and using small, data-driven improvement cycles. Rather than launching one-off initiatives, they test changes on a small scale, measure impact, refine what works, and then embed successful practices into standard work and daily management.