When techs need your attention

Poorly trained staff can affect the bottom line.

By Martha C. Tello, BA, COMT & Stephanie D. McMillan, MHA, COA

Ophthalmic staff members are increasingly seen as key performers in ophthalmologists’ offices, but, too often, practices have neither time nor resources to carefully monitor and assess their performance. Consequently, even a smooth workday includes disappointments, inaccuracies and misunderstandings, which feed into growing doubt regarding staff’s abilities. Questioning staff’s exam data, tests results and work ethic gets no one anywhere, fast.

As leaders, we need to help technicians improve their testing and communication skills to improve patient outcomes. Here, we share teaching strategies and methods to build a culture of constant improvement, awareness and quick corrective actions.

A lensometry workshop with technicians. A well-organized workshop provides hands-on practice, detailed instruction and constructive criticism.
COURTESY STEPHANIE D. MCMILLAN, MHA, COA

Improve patient communication

Communication and empathy, including making direct eye contact with patients, greeting and thanking them, are vital parts of a patient encounter. Saying “hello” means the world to a cataract patient who is nervous about the upcoming procedure. Instruct employees to smile when they introduce themselves, make eye contact and acknowledge patients when they first meet them. Also, provide a wait time (if any).

When a patient feels ignored or upset, that patient will feel discouraged and potentially perform low on tests. For instance, a patient who does not receive proper instructions for visual field will not be able to provide accurate results. Therefore, it is important for staff to show empathy and make the patient feel welcome by clearly explaining the exam process and testing protocols. The importance of patient interactions should not be minimized — it might come naturally for many, but not for others.

Your staff should do its best to communicate with patients and interact through any and all circumstances throughout the day. To continue to work towards patient comfort and ease, start each staff meeting by asking staff to share a great patient experience in clinic. Surely, they will be happy to tell other staff members how their patient interaction made a difference.

Confidence drives performance

Ophthalmic professionals must possess work ethic and professionalism. Even when scheduling a new staff member, you expect the employee to perform well. But what happens when a new staffer feels uncomfortable in a new setting? The answer depends on the individual and his/her desire to innovate and shine. Evaluate new employees’ progress during their first week to monitor their ability to perform accurate tests.

Lack of confidence in a new role could account for incomplete and inaccurate work-ups. This could happen when a staff member has some weakness that leadership does not properly monitor or identify. When employees are not consistent with giving the ophthalmologist accurate data, you must provide guidance and education. To help improve their skills, set goals for those employees and make sure that building confidence becomes a priority. Knowledge fosters confidence; so, team a staffer who lacks self-confidence with a senior member, based on the senior member’s talents.

Be practical, and don’t become a micro-manager — this takes away an employee’s freedom. Rather, focus on the employee’s technical skills. See how the person updates physicians’ protocols, completes charts and re-evaluates essential duties and responsibilities.

Remember that clinical staff are required to be licensed, credentialed and trained to various levels of clinical competencies. Your practice must provide time for clinical skills training and, as a group effort, identify when to train and when to trust.

For instance, if you see a trend in refractive inaccuracies, prepare an informative wet lab and hands-on session with a small group of technicians. First, go over the inaccuracies found through chart auditing, then proceed with questions on complex refraction cases, such as keratoconus and status post-penetrating keratoplasty. If needed, assign a skilled refractionist as a permanent mentor for those who require further assistance.

Monitoring staff results matters

To understand what teaching tools to use, measure inaccuracies found during end-of-day chart auditing. Finding weakness is a good thing, because it motivates both the training team and the clinical staff to pursue improvement methods.

When finding poor quality imaging in diagnostic testing, such as topography, specular, visual field, IOL biometry, photography, ocular coherence tomography, among others, keep in mind it may be due to staff’s lack of knowledge. Having them read instruction manuals for ophthalmic equipment gives them a clear understanding of how mechanics work in troubleshooting. These instruction manuals can have a large influence on training methods. For example, these ophthalmic equipment manuals often give a detailed look at the mechanics within the instrumentation and specify how the mechanism works. The instruction manual can be used to brush up on skills and improve techniques.

Example kinetic workshop

Q. Is this an equipment operational problem?	A. Possibly; the camera may not be in alignment.
Q. What troubleshooting is needed for the camera?	A. Manipulate the camera angle to overcome this problem.
Q. Is there pathology present?	A. Yes. An elevated chorioretinal scar.
Q. What aberrations/artifacts are included and how do you correct them?	A. Lid artifact is present. If it was the iris, the artifact would be a bluish tint. A white crescent around the picture indicates the camera is too far away and not in focus.
COURTESY STEPHANIE D. MCMILLAN, MHA, COA

Success is not about memorizing steps — results come when your staff understands the process, identifies challenges and physician preferences and keeps an eye on accurate results. Staff will still have good days and bad days, but you can limit the bad days by scheduling a weekly meeting to review challenging cases and sharing tips, experiences and common trends.

Emphasizing outcomes

Some technicians may think the job is done after the test is complete. But, it’s about more than speed — it’s also about accuracy. Looking at test results may not be on the priority list of ophthalmic clinical staff, but they are directly involved with a patient’s diagnosis.

For example, a physician who sends a cataract patient for corneal topography with a premium IOL in mind wants to document corneal pathology prior to surgery. If results show keratoconus or major astigmatism, a skilled technician would investigate refraction, compare results and ask the physician about a change of plans. If a technician performs the test and records data without questioning the IOL plan, it may be time for one-on-one training and a review of general ophthalmic knowledge, including diagnosis, treatments and prognosis to evaluate a potential need for further education.

Good testing technique also involves keeping staff in the loop and under review to ensure they remain proficient with ophthalmic equipment use and informed on basic skills, such as refraction, eye diseases and relevance of diagnostic results for treatment.

Conduct workshops

A well-organized workshop provides hands-on practice, detailed instruction and constructive criticism. Organizing a course helps improve clinical staff’s skills with simple tasks, such as lensometry. A more complex practicum could include basic ophthalmic photography with possible findings. Training methods varies depending on skill level. Beginners benefit from visual tools, such as video, Powerpoint presentations and ophthalmic books, while advanced staff would profit from kinetic exercises, such as grand rounds, wet labs and skills practicals (See the Example kinetic workshop, page 63).

Wet labs can give staff clinical confidence to perform tasks in a clinical setting. A simpler approach to a wet lab can have the staff practice a common ophthalmic skill, such as tonometry, on each other. Also, have your technicians keep a regular log of common mistakes, questions and tips. Employees can bring their logbooks to each training session to share and discuss these issues with the training team.

Conclusion

To improve staff’s technical skills, a practice must have experienced technicians. Growing with the practice is about more than gaining seniority through years of service — it requires improving and learning new skills, engaging in teaching and maximizing effort. OM

About the Authors
	Martha C. Tello, BA, COMT, is an ophthalmic technologist and clinical research coordinator with Bascom Palmer Eye Institute in Plantation, Fla. She has a Bachelor’s Degree in Leadership and Communication from University of Miami.
	Stephanie D. McMillan, MHA, COA, is the lead ophthalmic technician and a clinical and informatics trainer at Bascom Palmer Eye Institute in Plantation, Fla. She is currently obtaining her COT certification.