Taking Charge in the Exam Lane


Managing encounters with patients is both an art and a skill.  Either you run the encounter or the encounter will run you.  This is frequently one of the most difficult skills for new technicians to master. Conflicting Goals?

It seems we have competing interests: On one hand,;we strive to provide a welcoming and friendly demeanor, yet there are real time constraints dictated by appointment templates. Is this a no win situation?    I have found there are ways to satisfy both customer service and time constraints.

How to Manage Your Encounter with Finesse

Have you ever worked up a patient who wanted to engage in seemingly endless social conversations? What about the patient who won't stop joking around?  A simple yet effective way to get your encounter back on track without offending the patient is to say "Mrs. Smith, the doctor is probably wondering where you are. Let's get finished up so we can get you in to see him."  This is TRUE! The doctor probably IS wondering where your patient is. He is probably standing in the back hall looking at his schedule and wondering why he has yet to see Mrs. Smith whose short follow up appointment was 45 minutes ago!  The statement will not offend your patient; if anything, it may flatter them... ("Dr. Jones is looking for me and wondering where I am!").  I have used this technique many times over the years and it has worked without fail.

If you don't manage your encounter, it will manage YOU.  Take charge (but in a nice way).

Your Role in Patient Satisfaction

download Your job security is directly related to your practice's success and your practice's success is directly related to patient satisfaction. Therefore, your job security is related to your patients' satisfaction. 

How can you contribute to patient satisfaction?

Efficiency  No one enjoys waiting.  A study done recently found that patient satisfaction correlates with wait time. The study found "Minimizing the time patients spend waiting to see a provider can result in higher overall patient satisfaction scores" *http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754818/

Go the Extra Mile Give patients more than they expect. For instance, if it's pouring rain outside and a patient doesn't have an umbrella, offer to walk them to their car with an office umbrella.  It's the little things that mean a lot.

Use Positive Language  Instead of saying "I don't know" say "I'll find out".  Instead of "I can't do that - it's against our policy" say "Here's what I CAN do for you..."  

Be "On Stage"  You're at a work place, not a social occasion. When you are anywhere a patient can see or hear you be 'on stage". This means you have a professional demeanor and keep conversations and actions patient centered. When you're "off stage" (out of patient's hearing or sight) it's okay to let your hair down.

Avoid Calling Patients Pet Names like "honey" "dear" or "sweetie".  Some patients may be offended or feel patronized by these names. Terms of endearment should be reserved for close friends and family, not patients.

Work as a Team Avoid gossip and conflict with coworkers.  When everyone works together and pitches in to help each other out for the common goal of patient satisfaction work is seamless and both job satisfaction and patient satisfaction soars! It's a beautiful thing when everyone works as a team toward a common goal.


Efficiency Tips for Ophthalmic Technicians

download (1)I know.... I know... you're sick of hearing about the need for increased efficiency.  But keep reading. 'Efficiency' is not a four letter word.  Efficiency makes your work EASIER. Yep - you heard me right. When you work efficiently you're working smarter not harder. I was at the McDonald's drive through the other day. I got an unsweetened iced tea (I do love some Mickey D's iced tea). I asked the lady at the drive through for Splenda then I watched while she walked all the way over to the far side of the counter where the ice cream machine was to get Splenda.  Now, I'm pretty sure I'm not the first person who ever asked for Splenda at the drive through but why didn't anyone think to stock the drive through window with Splenda? Putting Splenda at the drive through window is more efficient... and creates less work for employees,

1. Keep your exam lane stocked. Having to retrieve items all day long is a real drag and makes you work harder.

2. Keep the following in your pocket:  *  Post it notes and pens  You can never have too many post it notes available   * A retractable measuring tape if you do refractions, measure convergence or accommodation. * a pupil gauge  *  a pen light  * a copy of the days' schedule  to keep you in the loop

3. Do away with the "Box 'o Bulbs" so many of us have in our office.  You know that box: it has bulbs, batteries and fuses in it. You never can find what you need, it's easy to take the last one and not know it and it's difficult to know what you need to re-order.  Here's how: Buy a bulb, battery and fuse for every instrument you have that needs one. Tape it (in its box or wrapper so you have the reorder number) to the instrument out of sight of the patient (such as underneath the slit lamp table or on the side of the projector that's toward the wall). When your bulb burns out, you'll have a bulb at your fingertips. When you take the new  bulb leave the box taped to the instrument. Once a month walk through the office and look for empty bulb, battery and fuse boxes. Remove them, noting on the empty box which room and equipment it goes to. Reorder from the product numbers on the package and re-tape each bulb to its instrument when the new bulb comes in. No paperwork - no muss, no fuss!

4. How to politely cut short a 'talker'.  "Mrs. Jones,  the doctor is probably wondering where you are. Let's get you finished up so we can get you in to see the doctor."

Can you think of some other efficiency tips? If so, share below in 'comments'.

Happy Tech-ing!


Does this Refraction Make Sense?

Your doctor will scrutinize your refraction, so why not learn to do it yourself first? Following are some strategies for analyzing your refractive findings: images (2)1.  A one diopter change in Rx should equal 3 lines of improvement on the Snellen eye chart.  Compare the spherical equivalent of the WRx and the MRx.   A spherical equivalent is a way to express a refractive error in a simpler spherical format for comparative purposes. Learn to do spherical equivalents in your head to compare prescriptions.

Here's how:  Take half of the cylinder, add it to the sphere and drop the cylinder and axis. For example: If the prescription is -1.00 +1.00 x 180 the patient's spherical equivalent is -0.50.  

If the patient had a one diopter change in spherical equivalent but only one line of improvement in VA, the refraction doesn't make sense. Recheck the refraction, the VA or both. 

Here are some refracting rules of thumb:

1. Always give the least amount of minus sphere or most amount of plus sphere that maximizes VA.

2. Give the least amount of cylinder that provides the best VA.

3. If there is a change in axis, ask the patient to compare their VA at the new axis and VA at the wearing axis. If the patient doesn't notice an improvement in VA at the new axis, keep the patient's RX at their wearing axis.

4. The more cyl the patient has, the more precise the axis must be.

5. If the patient refracts to 0.50 D cyl or less,  take away the cyl and ask the patient if they notice any difference. If they say it looks the same with and without the cyl, take it away.

6. The more ADD power, the closer the patient will hold things to read. If the patient is tall with long arms, they will likely need less ADD power. If they are short in stature, they likely will require more ADD power.

7. Give the patient the least amount of ADD that enables them to read the smaller print on the near card at their preferred reading distance.

8. The average reading distance is 14"-16". if the patient prefers to read much closer than 14" or much farther than 16"measure and note that reading distance on the chart.

Peanut Butter & Jelly Can Make a Point

I struggled with trying to get my staff to keep the exam lanes stocked. We had discussed the importance of doing so at staff meeting after staff meeting and it continued to be an ongoing problem.   My doctor had finally had enough the day she reached for alcohol prep pads and exam gloves and didn't have any in the exam lane she was using.  She came to me and vented.  We had a staff meeting scheduled for the following morning and I thought about my doctor's frustrations and how I could get the point through to the staff in an impactful way. The next morning, the staff gathered for our images (1)monthly meeting. I asked everyone "Who  makes peanut butter and jelly sandwiches for their family?" Everyone raised a hand. Then I asked "Who thinks they can make a peanut butter and jelly sandwich and pour glass of milk in a minute or less?" Again, everyone raised a hand.

I asked for two volunteers.  Cathy and Sue eagerly stood up.  I said,  "Let's time you both and see who can make a PBJ and pour a glass of milk the fastest." I had set up two stations where they could make their sandwiches. "On your mark, get set... GO!" I started the timer.

Both staff members set about making their PBJ. Almost immediately, Cathy turned to me and said "I don't have a knife for my peanut butter."  "Oh! I'm sorry! I must have forgotten to get a knife" I said, "Go run and grab one quickly from the kitchen."  Cathy ran into the kitchen while the other staff member kept making her PBJ. Finally, Cathy returned and set about making up for lost time until she went to pour the glass of milk and realized she didn't have a glass. "I'm sorry", I said - I forgot to get a glass for you. I'm sure there's one in the kitchen." "Cathy jumped up and ran to the kitchen again - this time smiling since she and everyone else present knew the point I was making.

By this time, Sue had completed her task - a delicious looking PBJ and glass of milk were sitting in front of her.  Cathy, returned with an empty glass from the kitchen. She was a little out of breath. She poured her glass of milk.  "Done!" she exclaimed.

I asked Cathy if she thought she could have beat Sue if she'd had all the supplies she needed. She emphatically said "Yes!"

I said "Sue isn't necessarily a faster sandwich maker but she was able to finish first because she had all the supplies she needed at hand.  Every time you have to leave your work area to get supplies you are making yourself less efficient and unnecessarily increasing patient processing time and patient waits. My staff finally got the point.

Sometimes you've got to think outside the box to drive home a simple point. The next time your staff meeting agenda looks like a copy of last months' agenda, see if you can use fun,  simple yet memorable ways to illustrate your point.

Strategies for Technician Training

download (2)The vast majority of today's ophthalmic medical assistants are trained on the job. The U.S. Bureau of Labor Statistics projects employment in this field will grow 30% from 2012-2022. Some regions of the US have tremendous deficits* of trained OMP therefore, training will continue to be a challenge that must be met head on for the foreseeable future. It can be a real challenge to find the time and resources for technician training. Various methods can be used in conjunction with one another to accomplish your training goals.  Training should be an ongoing pursuit over one's entire career  - not a one time event. Effective training pays for itself through increased competency and efficiency. Here are some strategies to consider:

1. Mentoring:  Identify your most proficient technician who also has good communication skills and interpersonal skills. Ideally, a formal outlined training program should be developed and followed so there is consistency, thoroughness and accountability for each new trainee.  Advantages: relatively inexpensive, hands on training is ideally suited for this type of training.  Disadvantages:  It may be difficult to identify an ideal trainer, training requires staff time which detracts from the trainer's productivity during training period.

2. Brown Bag Seminars: These are ideal for ongoing training in bits and pieces. Typically they are held during lunchtime. A variety of topics can be covered by the doctors, outside equipment or pharmaceutical reps or staff members (i.e. billing and coding can be covered by your billing staff).  Advantages: Inexpensive, typically require little advance planning, can be conducted frequently, doesn't interfere with office flow. Disadvantages: The short duration limits the complexity of topics that can be covered.

4. On Site Consultant: Bringing a seasoned trainer into your office for a specified period of time can help make the learning curve significantly steeper.  The quality and quantity of training provided immerses the trainee in the process and can catapult the trainee toward proficiency.  Advantages: You choose consultant and training based on your needs. You can schedule training at a time that is convenient for your practice. Training frequently can be conducted without interfering with patient flow. Consultants are typically experts in their respective fields, but be sure to check references. Hands on and classroom training typically offered. Training can take place at a time that's convenient for your office. Interactive by nature, trainees can ask questions of consultant trainer.  May be accredited for CE Hours.  Disadvantages:  May be more costly than some other alternatives unless many staff are trained at once (in which case, it may actually be cheaper than some other methods).

5. Off Site Seminars (i.e. Continuing Education Meetings):  Nothing can match the excitement of being at a large meeting with other technicians! Most technicians say they were inspired after attending a large meeting or convention. Typically faculty is fully vetted and well versed on topic. Advantages: Peer to peer interaction, competent faculty, CE hours, hands on training frequently offered. Disadvantages: Travel expenses must be taken into consideration.

5. Self Paced Study (i.e. books, videos, webinars):  This type of training is best used in addition to other modalities to augment learning.  Advantages: Relatively inexpensive especially considering you can train multiple staff members at once using same resource. Doesn't interfere with office flow.  Disadvantages: Hands on training difficult or impossible, usually accomplished through a virtual interface. Usually requires initiative on the part of the trainee