Reflecting on the 25^th anniversary of Ophthalmology Management (Congratulations!) and the fascinating modern history of ophthalmology, there are more highlights than can be properly covered. What does stand out is the profession’s continual drive for innovation.

From Dr. Charles Kelman’s phacoemulsification technique and Dr. Patricia Bath’s Laserphaco Probe to retinal injection treatments, premium lens technology and in-office cataract surgery, innovation remains an abiding force in this specialty.

In contrast, the effective business of medicine — and the underlying leadership needed to drive any business forward — relies more on approaches that are relatively unchanged over the last century and more in the industrial world. Examples include inclusive communication, consistently applied written protocols, ever more fairness to the workforce, showing appreciation to staff for their efforts to care for patients kindly and professionally and the exhaustive training and re-training so that employees know how to meet your expectations.

This is not to say that business methods are entirely stagnant. New tools, spreadsheets, scorecards, psychologically based trends and methods to improve teambuilding and staff morale are constantly being developed (often in non-medical settings and then eventually applied in health care.)

The most timeless key to managing the workforce in your practice (your greatest monthly expense) is to stick with the timeless basics — and this starts with onboarding and fully training new employees.

To successfully onboard a new employee, multiple steps are required. Many of these steps apply to all new employees, and some are specific to the position. The goal is to avoid the new employee being ill-prepared as well as the common feeling of being overwhelmed if they are poorly prepared.

When this happens, employees may keep these feelings to themselves but, at about the 3-month mark, feel like they will never meet your expectations and leave.

Few things are more frustrating in a practice than this kind of “catch and release” HR problem — continually losing new employees after spending the time and resources to find and train them. If this happens regularly in your practice, it is time to tune up the onboarding process.

Here is a list of some simple reminders of where you may be falling short.

ONBOARDING STEPS FOR ALL

1. Send a welcome-to-the-practice letter. Receiving a warmly worded letter prior to the first day of work sets the tone for a mutually beneficial working relationship.
2. Formally prepare, in advance, for each aspect of orientation and training. Determine who will be responsible for orienting in each area, for each task. In practices without official trainers (which is often the case), the process is smoother if the department manager of a new staffer has reviewed with the existing staff the process of how the new employee will be educated, who they will shadow and who best to ask questions. Planning ahead prevents the unfortunate situation of an existing employee not being thrilled about this unexpected responsibility and then sharing those negative feelings with your new employee.
3. Create an operations manual. Ideally, each department in the practice has an operations manual full of policies and procedures that specifically delineate “how-to-do” all the main responsibilities of each position. For existing staff, it is a good reference as policies are updated over the years. And it becomes a wonderful training manual for new employees, who can make notes on their own copy of a policy rather than depending on memory or quick notes taken as they initially learn.
4. Make a check-list of the position responsibilities. This is very helpful for both the trainer and trainee. One example of this checklist is to create a four-column table that lists each task/responsibility down the left side in column one. Column two shows the date the training was completed. Columns three and four are for the employee and manager signature, showing that the employee acknowledges their understanding of how to do the task and the manager agrees that the employee has been fully prepared. Reviewing the checklist together gives the employee the opportunity to say they need more assistance and the manager to acknowledge that more skill is needed in that area.
5. Assign a mentor to each new employee. The mentor becomes someone the new staffer feels comfortable asking questions and has been vetted by a manager as a knowledgeable and helpful colleague.
6. Check in with new employees often throughout the early weeks. This allows the administrator or department manager to get feedback on how their onboarding has progressed and if any gaps need to be addressed.

ONBOARDING PRACTICE ADMINISTRATORS

1. Provide the time needed for self-orientation and learning about the practice. Ideally there is a coordinated effort to pass the leadership baton, but in many cases there can be only a very perfunctory hand-off. Try to hold back your new hire from jumping into the thick of it prior to understanding how the practice functions, wanting to prove themself to you immediately.
2. Have the administrator spend a few days in each department. Even better is for them to sit with at least one employee in each position to see how they do what they do. Not only does it provide the opportunity to meet the staff, but it also will help the administrator understand the processes in place that could benefit from being streamlined in the future.
3. Meet weekly. The managing partner (or all owners if there is no designated MD-leader) and the new administrator can share ideas and provide each other feedback, which helps to develop a great working relationship and to understand each other’s priorities.

ONBOARDING A NEW DOCTOR

1. Check in during recruitment. Doctors are often recruited many months — even a year or longer — in advance of their start date. During this time, have practice owners call and email on a regular basis. In larger practices, the administrator should stay in close touch. These efforts help to retain the newly recruited by making them feel wanted.
2. Develop a plan for EHR training. Sometimes this can happen in advance of actually starting clinical work. If not, provide the time for the doctor to learn with the help of an experienced scribe. You want to avoid a bumpy start where the doctor becomes frustrated with the EHR while trying to make a great impression on their new patients.
3. Prepare their desk or private office space in advance. A clean area with a place for books, photos and a coffee mug feels welcoming.
4. Share the practice contact list (phone numbers, email addresses). This will help direct the doctor to whom they need to speak with efficiently. An organizational chart is very helpful as a visual tool.
5. Schedule a one-hour meeting with each department manager. This allows them to review what is accomplished in each department, how they can be supportive and what they can reasonably expect from each other. (In the best settings these orientations start during the interview process, and department heads have a critical voice in screening candidates.)
6. Assign a physician mentor. In our consulting rounds, we still see new doctors who are not provided much assistance when they join the client’s practice. Welcoming a new doctor and providing extensive orientation is key in our current hiring environment.
7. Explain referral outreach and networking. Be specific about who to contact and how often you expect them to be active with outreach. Misunderstandings are common in this area (eg, existing partners are disappointed in the perceived lack of effort) and can be avoided by setting expectations and communicating about it regularly ... from the beginning.
8. Don’t forget the basics. This includes business cards, office signage, patient appointment templates, a welcome sign in the lobby and trained staff ready to help from the first day. OM

Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has over 30 years of hospital, physician practice management and management consulting experience. Her latest book, co-authored with John Pinto, is “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction”. For information on how to purchase this book or other inquiries, she can be reached at czwohl@gmail.com or 609-410-2932.

John Pinto is the founder of J. Pinto & Associates, Inc., an ophthalmic practice consulting firm established in 1979. He is the most published author in the world on the subject of ophthalmic management and economics. The firm serves organizations worldwide, ranging from solo practices to high-volume market leaders, teaching centers and medical product companies, providing strategic planning, financial benchmarking and analysis, operations enhancement, and marketing counsel. He can be contacted at pintoinc@aol.com or 619-223-2233.