Managing staff and patients during COVID

One practice’s experience with safety regulations and vaccines

By Stephanie Becker, MD

Returning to full office hours following the COVID lockdown has been stressful, to say the least.

While my office remained open throughout the pandemic, it took a lot of time and energy to figure out how to keep everybody safe. Like many practices, we faced obstacles such as reworking our cleaning and sanitation protocols, procuring PPE at greatly inflated cost, calming through-the-roof anxiety in our patients and trying to financially manage as a small business owner during lockdown. The hardest of all has been handling employee issues.

RETHINKING SAFETY

We all have so many things to think about as we embark on our new normal. Unfortunately, business owners have been pushed into the position of being “COVID cops.” The CDC announced on May 13 that vaccinated workers could drop their masks in most situations and no longer needed to social distance. But with the vaccination status at about 70% in New York state, where I practice, the doctor in me realized that it meant 30% are not. Regarding nationwide numbers, 78% of AAO members said that 75% or more of their staff with patient contact were vaccinated according to a June survey. The mask mandates have varied state by state, and the FDA does not mandate vaccination. This inconsistency has generated epic levels of confusion for business owners regarding how to handle or require COVID vaccines and/or mask use.

The political climate has complicated the issue further. The use of masks and COVID vaccines have been polarizing issues for both patients and employees. What is the best way to handle these complicated times while also keeping patients and staff safe?

VACCINES AND EMPLOYEES

I’m sure everyone has read the case of the hospital system that required vaccinations. They had 127 employees who sued because they did not want to be vaccinated, and the employer prevailed.

In a smaller office, it’s much more complicated when we have personal relationships with our team members. Put that in the context of national shortages of employees, and do we want to require an employee to get a vaccine, which is not FDA approved, if they are ardently against it due to health concerns, religious beliefs or other reasons? (I recently learned that two employees in my practice absolutely refuse any vaccinations.) As employers we have basically three choices: We can require vaccination, we can suggest vaccination or we can continue stringent mask policies. I don’t pretend to have all the answers, but this is how my clinic handled vaccinations and mask requirements.

In my office, we have required staff to continue to wear masks in all areas except our staff lounge and lunchroom. For our employees, we are back to another three choices: We can rely on the honor system and assume anyone without a mask is vaccinated, require proof of vaccination if the employee wants to use the staff areas with no mask or have all employees sign an office policy stating that they will wear a mask if unvaccinated. We have chosen the third option. It seemed the most reasonable to me, and my staff has signed similar policies regarding hepatitis B. So, it took a little bit of the emotional weight out of that office policy signature.

While I did consult with a labor attorney on this issue for my office, this article is not intended as legal advice. Every state differs on whether you can require or mandate COVID-19 vaccination, and one phone call to your friend the labor attorney can save you a lot of headache later on. And for who want tips on talking to staff and patients about vaccinations, the AAO published some guidance (tinyurl.com/yc5byaat ).

PATIENT SAFETY MEASURES

In the context of our medical and surgical practices, we should continue to use the utmost level of scrutiny and care and continue to use all the precautions we put in place during the height of the pandemic. (For additional CDC recommendations, visit tinyurl.com/9wxrpsta .)

My practice instituted infection control and cleaning procedures for all exam rooms and patient testing and treatment areas, and we removed magazines and brochures that could be touched and used as a contact source of transmission. We blocked off chairs in the waiting room so that patients could not sit closer than 6 feet from each other.

We removed the water cooler from the waiting room and have signs on every door about our mask policy, social distancing requirements, handwashing techniques and requirements and contactless payment options. And, of course, hand soap and sanitizer are everywhere.

We have gotten some pushback from patients who would like to take their masks off and sit wherever they want to. We calmly explain to them that this is for their own personal safety.

I document vaccination status in the patient’s EHR — although I only ask for a copy of their vaccine card if they are willing to give it. (The exception to this rule is for surgical bookings. My ASC needs the vaccination card if the patient does not want to have PCR testing prior to their procedure.)

It’s been a long 18 months since the COVID-19 pandemic started, but continuing to follow safety measures will go a long way to ensuring the health of both our patients and staff. OM

Evaluating clinical staff performance

The fourth in a five-part series on technician recruitment and retention

By James D. Dawes, MHA, CMPE, COE

Administrators, practice managers and human resource managers are tasked with the “annual performance evaluation” of our employees. For many, this can be a grueling and mundane task that results in very little actual performance improvement and often results in disgruntled team members who are unhappy with whatever raise they may or may not have received.

Rather than look at the downside, try to see the 90-day and annual performance evaluations as a great opportunity to dramatically improve essential skills of our technical teams. As I have stated in previous articles, clinical technicians are key to organizational efficiency and revenue production. It is incumbent on us to use this time with these employees for motivation and career development and to make the experience enjoyable and productive for all parties.

SIX EVALUATION CATEGORIES

When designing technician performance evaluations, I consider six categories:

1. Skill. The ability to effectively and independently complete specific ophthalmic technical tasks (ie, manifest refractions, pressures, OCT)
2. Aptitude. The individual’s ability to quickly learn new skills
3. Attitude. The individual’s overall willingness to support the team and organization’s goals and to provide exceptional patient care
4. Professionalism. The individual’s overall demeanor appearance, adherence to dress code and communication to other team members
5. Professional development. Whether the individual has advanced their career through additional certifications and continued learning (ie, COA, laser certifications)
6. Experience. The team member’s ophthalmic, optometric or surgical experience as applicable.

THE CATEGORIES AND PAY SCALE

There are two schools of thought as to whether the employee’s annual compensation adjustment should be directly tied to the performance evaluation and discussed at the same time. I fall into the category that the two should be done simultaneously. I like to use the six categories described above as a weighted scoring method to determine where the individual should fall in the pay scale.

For example, a practice may weigh skills as 35% of compensation, aptitude at 10%, attitude as 15%, professionalism as 15%, professional development as 10%, experience as 15% and then assign points accordingly. I assign 1 to 4 points in each category with 4 being the highest value of points achievable. The more points scored drive the movement upward in the pay scale. So, if a technician, scores 3s in skill and experience and scored 4s in aptitude, attitude, professionalism and professional development, those additional points in the “intangibles” can help the employee’s efforts to be recognized. On the other hand, if an employee has great skill and experience but lacks the intangible skill sets, their compensation will suffer accordingly.

I heavily weigh ophthalmic technician skill as the highest category because that is what drives efficiency and productivity. And, as technicians learn more skills and become more productive members of the overall clinical team, they are compensated at a higher rate while not ignoring the other important characteristics of great employees.

MEANINGFUL EVALUATION

The point of the exercise is to make sure the performance evaluation is meaningful and drives career, skill and personal development. True engagement with our technicians on these topics not only creates a better team but helps them to understand the “why” behind their compensation structures and helps them to directly to control their own destiny by focusing on specific performance improvement goals.

My examples are simply methods I have adopted. There are several mechanisms practices use to accomplish these goals. The key is that they are unambiguous and applied consistently across the clinical team.

Also, these reviews take time, and the necessary amount of time should be allotted from a scheduling standpoint for all parties involved. The annual review is something most employees look forward to — make it great.

In my next installment, I will wrap up this five-part series by talking about some of the intangibles that make the work experience great as well as how you can create fun, productive work teams and make staff excited about their career and your organization. OM