By Dave Anderson, OD
Jan. 4, 2017
In a busy optometric practice, ODs must rely on staff. With proper training and delegation, staff members can be valued partners with the doctor in delivering outstanding patient care and service.
Our practice has 19 staff members and four ODs. Since we opened in 2010, we have steadily grown, adding about two staff members each year. We felt we needed to have four staff per OD, plus three managers. We have a consistent system of delegation, thus requiring a constant staffing level based on our doctors’ schedules.
We have a cross-training system that continues to expand our staff roles in the office, which allows us to delegate, regardless of who is available each day.
By having our office tasks assigned as we do, we have been able to add two more comprehensive exams to our schedule per day, while freeing up my lunch and end of the day. Ordering a gas permeable contact lens with special modifications may have taken 15 minutes in the past, and may have reduced my lunch hour, but now this is done by our staff. I estimate the addition of the extra patients generates an extra $30,000-$40,000 a month based on the average revenue of $350 per patient exam for the four doctors.
How We Assign Tasks
Our ODs are in the exam room dealing with patient care nearly 90 percent of the time. All doctors perform patient refractions, eye health exams and provide counseling for the patient.
All of the pre-tests are performed by our staff, including visual acuities, screening visual fields, pressure, history, blood pressure or any other specialty test like OCT, visual fields and retinal photos or topography.
Our staff also handles all post-exam tasks, including contact lens fitting, evaluation and ordering, and glasses fitting and ordering.
Know What NOT to Delegate
Any test, or patient history task, required by insurance companies are always performed by the doctor. Anything requiring medical decision making is always performed by the doctor, however, with scribes in the room, much of the documentation for exams is delegated.
The biggest factor in delegation is to choose tasks that are data gathering or education tasks. Anything that is related to making a decision about patient care should always be performed by the doctor.
Who Do I Delegate To?
Delegation happens in many ways during the day, but having a highly trained and cross-trained staff allows most staff members to handle most situations. However, there are certainly some who are better suited for certain tasks. One example would be a contact lens fitting for a very timid child. We have six staff members trained and able to help provide the education and proper training for contact lens patients. We have three that do this on a very regular basis, but one of the other three is very good and extremely patient with young children, and we use her to help with some of these difficult fits for young kids.
Increase Staff Engagement
Often we can see our staff finding their jobs stale, so we are always looking for more ways to delegate. Just recently we added contact lens evaluation by staff to the delegation list. We have two, and plan to train an additional three staff members to handle some of the more straightforward contact lens follow-ups and patients requiring just a small lens change. The typical situation may be a small change in the contact lens power for a mono-vision patient, or a change from a monthly lens to a daily lens for established wearers. We work to train our staff for these situations, teaching them the subtle things to look for in these situations, and continue to show them what lenses look like as they gain confidence before they are on their own. At this point, two of our staff are handling this with ease and enjoy the additional challenge.
What makes delegation successful is constantly providing feedback and direction to our staff, so the job is performed correctly. Occasionally when a new staff member begins performing visual fields, they may forget to check the patient’s blood pressure, or eye pressure, and a simple reminder is provided so they can review the manual or procedures and avoid making this mistake again.
Review to Ensure It’s Working
When every part of a project is critical, and anything left out leaves the job unfinished or un-ordered, we carefully review. For example, for eyeglass orders, we have a system in place where reports are run at the end of the day to ensure orders are placed, payments are collected and all tasks are completed.
Assign Some Tasks to Multiple Employees with a Designated Leader
We have situations where some of the business tasks require many hands, such as reconciliation of our frame board, or pricing changes for frame lines. Here the key is having one key person in charge. A manager might be a point person, further delegating but being accountable for the project’s success.
Look for More Potential Delegation
We have considered delegating refraction to staff, but we have a difficult time with this. Refraction is a huge part of our practice, and not having a doctor performing refraction may be viewed poorly. We have given more freedom to our HR manager related to staff training and staff reviews. In the future, we may also add payroll and staff bonuses, as well.