Analysis: Choosing between growth and death?

Key Points

"Growth itself contains the germ of happiness." - Pearl S. Buck

"You will either step forward into growth or you will step back into safety." - Abraham Maslow

"I think that our fundamental belief is that for us growth is a way of life and we have to grow at all times." - Mukesh Ambani

Conveniently, in the little Maryland town where I live is a tiny mall with a Starbucks next to a Barnes and Noble bookstore and my bank's ATM. If I don't feel like getting my coffee fix there, another option is the Starbucks located in the same mall, adjacent to the Trader Joe's I frequently patronize.

Here's the interesting thing to me. Walking from one of these Starbucks to the other takes less than one minute. Admittedly, most people say I am a fast walker, but having two of the same vendors a few hundred feet apart strikes me as crazy.

Maryland is not the only state with this interesting redundancy. Recently, on a trip to California, I saw exactly the same thing: two Starbucks in the same shopping mall.

Admittedly, many business gurus believe that companies and organizations must continuously grow, or they will atrophy and eventually die. But as a doctor, and not a high-powered chief executive officer (CEO)/captain of industry, the rationale for such a high density of coffee vendors to feed America's addiction had escaped me for quite a while.

As proof that sometimes when things don't seem to make sense, they actually don't, Starbucks is now shrinking. Howard Schultz returned as CEO of the company, and has announced that 600 locations will be closed across the country, and 12,000 employees terminated.

There is an inherent tension between the appeal of maintaining a successful, secure business and the desire to expand the business, recruit new stellar employees and grow market share. Some authorities maintain that the former strategy is a recipe for stagnation, atrophy, and eventual death of the organization. As Maslow says, the decision not to grow is a decision to step back and "play it safe." On the other hand, overexpansion can risk financial damage, and result in the sad situation of terminating good employees and damaging the morale of those who remain.

Ophthalmologists in practice and departments of ophthalmology often face the challenge of deciding when and how to grow. Adding well-trained and highly motivated new partners brings new talents, perspectives and skills, reinvigorates the practice, and makes work more fun. On the other hand, if the practice grows too quickly, adding staff, equipment, facilities, and satellite locations without a correspondingly rapid increase in patient volume, overhead will increase to an unacceptably high level. Waiting too long to grow, however, can result in excessive waits for patient appointments, overworked staff, high stress, and poor customer service.

So it can be difficult to decide when to start looking for a junior associate or new assistant professor, especially given the long time that may be required to identify and recruit a stellar person. In my view, it is much more common for practices and departments to wait too long before beginning the process of adding excellent people to build upon a successful and vibrant operation.

By Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278
Phone: 443/287-1511
Fax: 443/287-1514
E-mail: pmcdonn1@jhmi.edu

Reference

• "Tall Order." http://Portfolio.com/. July 3, 2008.