Imagine you oversee the clinical team at a busy eye practice. After persevering through a period of being short staffed with full schedules, you finally get everyone trained on all machines and physician preferences. As you let out a deep breath, your boss calls you into a room for some exciting news. Two new diagnostic testing machines are arriving today, our surgeons will start implanting a new IOL tomorrow and the team needs to be trained on all of this by next week! Anyone who has managed a clinic doesn’t have to employ too much imagination to place themselves in this scenario.

Now of course, this would be great news! The practice is likely growing, and you have been entrusted with part of the success in that growth. However, to be prepared to handle these changes, it’s important to analyze the challenges and potential pitfalls.

As a practice administrator at Center for Sight in Las Vegas since 2017, I have coordinated the implementation of multiple new technologies, including diagnostic machines, novel treatments and a new EHR system. Through many hard lessons, I have learned that it is important to analyze the challenges and potential pitfalls when adopting new technology and to have a customizable process in place when introducing anything new.

Whether your practice is implementing a new piece of equipment or a new IOL, integrating new technology requires a thoughtful, well-planned approach. In this article, I will discuss the processes that we have implemented when adopting new technology as a practice and how they have benefitted our practice and our patients.

ASSIGN AMBASSADORS

Leaders understand the need for a project lead when rolling out new technologies. If the manager isn’t leading the rollout, the task of tracking and driving the project should be delegated to an ambassador. This person can help convey the value to the practice and ultimately the patients. This person can be line staff, management or even a physician. They don’t necessarily need to rank high in the organization or hold an additional title to be impactful. However, having a physician ambassador can be very powerful in getting staff on board.

For example, at Center for Sight, we assign a physician ambassador whenever we adopt a new technology. We have a crosslinking ambassador, a dry eye disease (DED) ambassador and even had one for our EHR when we migrated to the platform. The physician ambassador not only offers expertise but communicates to the staff that this is important and worth our time to learn.

We recently implemented a preoperative planning software with the goal of decreasing the amount of time spent on surgical planning for each patient.¹ Since we have dreamed of a system that streamlined preoperative planning for years, it made sense that we quickly integrate the technology. While the benefits of using a system like this are obvious to a surgeon and the surgical support team, the larger team may not see it the same way.

Because any change to a preoperative process in a high-volume clinic impacts many people, we leaned on our surgeon ambassador to promote the technology amongst her fellow surgeons and help educate staff on processes and benefits. First, we ask the surgeon ambassador to personally announce the new technology to the entire practice. Then, we facilitate a mini presentation at our quarterly physician meeting where they can offer insight and answer any questions. Lastly, we make sure to include the ambassador in any communication or staff meeting that involves establishing the process for the new technology.

With the encouragement and buy-in from our surgeon ambassador, the team is less likely to resist the change and will see the new technology as an opportunity to better serve patients.

TRAIN STAFF

Asking a rep to drop off some pamphlets or come by for a “lunch and learn” takes up valuable time and often misses the mark. Not only does the team lose the sanctity of the breakroom that day, but the “learning” is usually signing in and taking a glance at the brochures fanned out on the counter. These types of sessions are valuable after the staff is well-trained but should not be a replacement for customized training.

Training should be relevant and considerate of the team’s busy day. Ideally, those responsible for training should break down staff into two groups: those who need to be generally aware and those who need to be fully trained on the details.²

Those who need basic information are staff who do not come into direct contact with the device or those who are not the primary patient educators. This may include front desk staff who do not operate diagnostic machinery or a technician who does not educate patients on options for surgery. They should have an “elevator pitch” they can deliver to patients with confidence when asked about the device or treatment.

Staff who come into direct contact with new devices or technologies should receive a higher level of training. In addition to the basic training offered to all staff, techniques such as role playing, assigning quizzes and holding roundtable discussions with reps or doctors are all effective ways to achieve deeper understanding.

When we introduced an intense pulsed light device to our practice as a treatment for patients with DED, we had to formulate a plan to get everyone in the practice trained. We coordinated small sessions with our call center and front desk teams during which management covered the basics of DED and how IPL can treat qualifying patients. For our back-office staff, we set up multiple sessions with the clinical trainer from the manufacturer of the device. They covered clinical information and shared some tips for the workup and counseling session. There was also a hands-on portion for the staff assisting in the administration of the treatment.

The staff was very appreciative of the custom, focused approach as opposed to the large session where everyone is exposed to the same generic material.

CREATE PRACTICAL TIMELINES

As passionate health-care leaders, it is easy to let our high expectations and excitement to serve patients inadvertently set ourselves up for failure. While part of our job is to maximize efficiency and minimize down time due to training, another part is setting realistic timelines driven by data and objective analysis. To set a timeline for training, we often start by working backwards from the main outcome goals.

Ultimately, we want all staff trained and to maximize the number of patients benefitting from new technology. The first part of that goal requires careful attention to the time and resources required to achieve a fully trained staff. Training needs vary by staff type; therefore, training timelines will depend on staff type as well. The final deadline should be in line with the longest minimum timeline for staff training.

Maximizing the number of patients who benefit from the technology can be done utilizing the pro forma that was used to justify the purchase or with a volume goal set by ownership or management. Once a patient volume goal is established, we can again work backwards from that goal to determine the number of staff members that need to be trained at each touchpoint and what adjustments need to be made to the existing schedule template. The new technology needs to fit into the greater practice and can’t disrupt the established clinic.

ESTABLISH OBTAINABLE TRAINING GOALS

It is important to establish training goals for each specific staff group. Perhaps you can start with a list of things the participant should know by the end of the training session(s). You could also administer a test that can include a demonstration to assess skill in addition to knowledge, if needed.³

To avoid conflicts with work schedules, consider leveraging a learning management software like Litmos or Absorb to roll out virtual training that staff can complete outside of busy clinic hours. Once a focused approach is established and executed, ongoing lunch-and-learns or “all hands” trainings can be effective. Once again, these general sessions should not be seen as complete training but rather part of the ongoing education following a more structured approach.

DEVELOP SCRIPTING

Everyone remembers the game of Telephone. You send a message around a group of people, with the goal of getting your original message back at the end. However, often by the time you hear it again, the original message has been lost! Sometimes innocuous additions or retractions occur, while other times the message has become something else entirely.

Training staff with verbal scripts and approved patient messaging works in the same way. When the script is introduced, everyone believes they have memorized the script verbatim. However, after a few days and weeks pass by the script will vary from person to person. The level of variance depends on the person, but the outcome is usually the same.

While it may seem like micro-management and unnecessary to some, it is paramount to establish common, documented scripting to be used when educating patients on core services or new technologies. The key stakeholders should work with the medical director or lead physician to establish a common script for physician use. Based on the accepted scripting used by physicians, the entire staff should be given common language to use in patient education.

One of the fastest ways to lose patients’ interest, or worse, their respect, is to use over-complicated jargon or unnecessarily complex terminology during an interaction with a patient. So, the accepted script should be easy to understand for patients.

Patients lose confidence when they hear different explanations for the same question. Conversely, patients gain confidence when scripts are consistent and succinct.

CHALLENGES WITH PRICING

Pricing a new technology is an opportunity to convey value but comes with a few challenges. When the technology is an innovation to an existing product or service, we can use comparable services and a market comparison to set the price. When the technology is truly novel, we need to use more data points and a more traditional pricing process. In either case, the patient needs to understand the value and the benefits of the technology. This is especially important for services that come with more out-of-pocket costs. Patients often need help understanding the difference in cost for a covered service that can be billed to an insurance and an out-of-pocket service that is not covered. For the most part, your pricing structure should make sense to a patient from a value perspective while being set up in a way that make the offerings viable and profitable for the practice.

CONCLUSION

When integrating new technology, start by analyzing the challenges and potential pitfalls when adopting new technology; make sure you have a customizable process in place when introducing anything new. To ensure a smooth implementation of new technology, try assigning ambassadors for the project, conducting staff training, using common scripting and creating practical timelines and obtainable training goals for your staff. This has proved beneficial for our practice and our patients. OM

REFERENCES

1. Gujral T, Hovanesian J. Cataract Surgical Planning Using Online Software vs Traditional Methods: A Time/Motion and Quality of Care Study [published correction appears in Clin Ophthalmol. 2021 Aug 10;15:3283]. Clin Ophthalmol. 2021;15:3197-3203. Published 2021 Jul 28.
2. Canadian Medical Association Journal. Doctors need retraining to keep up with technological change. https://www.cmaj.ca/content/190/30/E920 . Accessed September 9, 2022.
3. Centers for Disease Control and Prevention. Recommended training effectiveness questions for postcourse evaluations user guide. Atlanta, GA: CDC, 2019. https://www.cdc.gov/training/development/evaluate/training-effectiveness.html

Preston Rawlings, COE, is the director of operations at Center for Sight in Las Vegas. Email him at Preston.rawlings@c4slv.com.