The administrator called me asking for help. She said her doctors had been getting a lot of glasses remakes and unhappy optical patients. Additionally, the doctors had lost faith in their technicians' VA's and IOPs measured with a Goldmann Applanation Tonometer. The doctors and administrator were befuddled because their 30+ technicians had been doing well but seemed to have faltered over the past year. They asked me to come to their office and spend three days with their technicians. Evaluating the Problems
I began by simply observing each technician as they processed patients. This took a full day given the fact that there were more than thirty technicians, but by the end of the first day I knew exactly what the problems were. What I discovered is that a technician with many years experience had been hired a year prior and had been put in the role of head technician and trainer. Unfortunately, this technician was not as well skilled as she (or the practice) thought she was. She had spent the past year re-teaching all of the technicians erroneous skills.
This practice worked in plus cylinder but the technicians had been trained to 'chase the red' (!) This one error was perpetuated from technician to technician until only spherical patients were getting accurate refractions. Additionally, the technicians were measuring VA incorrectly. They recorded VA as the last line of letters they read all of the letters easily. The technicians were also taught to align the Goldmann applantion tonometer mires into the shape of an 'S' rather than 'just kissing' resulting in erroneously low IOPs.
Light Bulb Moments
I spent the next two days re-training the technicians on VA, refraction and GAT and by the end of the third day, they were all accurately refracting, measuring VA and GAT. The technicians had many 'light bulb moments' and It was a happy ending for everyone except the head technician who unfortunately, was demoted from that position. It was sad, but necessary.
My Two Cents
When you're new to the field, you only know what you're taught. If you're taught incorrectly you won't KNOW you've been taught incorrectly. This is why it's critically important to ensure technician trainers know their stuff. Don't be shy about doing 'working interviews' with even the most seasoned technician. It's the only way to be sure they have good skills.
When you assign a lead tech or technician trainer, TRAIN THE TRAINER. Ensure this trainer gets support from the practice in the form of continuing education and feedback and mentoring from the physicians.
A Happy Ending
In the end, the fixes for this practice were easy, but it took an outside person who could devote the time to evaluating each technician's work up to find the root of the problem. I called the administrator a few weeks later and asked how the clinic was going. She said the doctors were thrilled with the quality of the technicians' work and their glasses remakes were down dramatically and the technicians said they felt more confident in their skills. She told me they estimated my services had saved the practice 'tens of thousands' of dollars. That was great to hear... but the best part for me? Better patient care.