Optometric Management Tip # 160 - Wednesday, February 09, 2005
Staff Turnover and Training
Most optometrists agree that staff management is one of the most challenging aspects of practice
administration. We know that an excellent staff is a prerequisite to a great practice, but it’s not easy
to keep everyone happy in a busy office. As the practice grows, so does the number of staff, which just
complicates the management issues. In spite of the fact that this newsletter is read by bosses and
workers alike, I’ll address some key issues that can reduce the frustration of staffing.
Human resource management is a complex field with many facets. Recognize that as your practice grows, so
will the time and effort necessary to successfully manage people. While I believe in hiring an office
manager early as a practice develops, I also believe that the practice owners play a vital role in staff
management. The doctors in a practice bring vision and leadership, and they have a huge influence on
office culture. To reach the ultimate in practice success, doctors must care about staff issues and spend
time on them. I’ve long been an advocate of reducing the number of days the owners spend on patient care
as a practice grows, and increasing the time spent on practice administration. This, of course, requires
the addition of associate doctors to see more of the patients. Practice owners who want to achieve growth
must accept the fact that their jobs are slowly changing from optometrist to CEO, and in small businesses,
much of the work of a CEO is that of a general manager.
What makes an employee happy with his or her job? What makes a staff member remain loyal to an employer?
The answers to these questions are broad and varied, but the sum total of all the factors is called “job
satisfaction”. While wages and employment benefits are certainly big factors in job satisfaction, they
are not the only ones and maybe not even the most important. But there must be some factors that lead to
job satisfaction, or the employee will look elsewhere and eventually quit. Employment exists within a job
market – so the good and bad in a job is relative to what else is out there. Optometric practices must
compete for good people not just with other eye care practices, but with all employers in the area.
If the duties of a job are difficult, unpleasant or dangerous, the wage will likely be higher. If the
wage is relatively low, then working conditions and job duties must be pleasant and rewarding in other
The job market has many similarities to the commercial market. The prices of goods and services are a big
factor in retaining customers, but not the only factors. In our commercial market of eye care, we
approach our marketing plan by asking, “Why should patients choose my practice?” This can be a tough
question to answer, and it holds the key to your success. We should approach our staffing philosophy in
the same way: “Why should an employee (or job candidate) choose to work for my company?”
I’m sure there are many good reasons why employees want to work for your practice, but the more reasons
you provide, the more demand there will be to work there. Similarly, the more reasons you give patients
to select your practice for eye care, the more appointments you’ll have. As we try to identify and
satisfy our patients’ wants and needs, we should also seek to identify and satisfy our employees’ wants
and needs. I call this “marketing to the staff”. Staff members are, after all, our internal customers.
Organizational culture is an extremely important aspect in the workplace, and yet it is an intangible that
you may not have thought about. All practices have an office culture, although it may have developed by
pure chance, rather than by design. Simply described, organizational culture refers to the unwritten
rules about what is expected of employees in a business. It dictates behavior on the job and affects
how people feel. This culture may be liked or hated by employees and it often contains many of the
non-wage factors affecting job satisfaction, discussed above. Consider these aspects of organizational
culture as they apply to your practice.
- Fairness in policies. Are policies written down and applied to all equally?
- Respect. Are employees treated as fellow professionals? Is rude or inconsiderate behavior looked
- Self-actualization. This trait is achieved when employees feel that their opinions matter and will
influence the job. It makes people feel like their ideas matter.
- Opportunity for growth. All practices, big or small, can offer growth opportunities to staff members
through increased delegation and responsibility.
- Employee involvement in the organizational mission.
- Interdepartmental cooperation. Does the business office want to work well with the clinical
technicians, and visa versa?
- Hierarchy of power and ease of upward communication. Can employees speak easily and freely to the
- Defensive culture. Do employees try to protect their status and security?
Staff training is a constant need in any practice, due to turnover and growth. In smaller practices,
the doctor often does all or most of the training of new staff, but as it grows, this task can be
gradually delegated to other senior staff. Here are few areas to reflect on as you consider your training
- Job descriptions. Typical departments in an optometric practice are: business office, patient care
(includes contact lenses), optical dispensary, and optical fabrication lab.
- Cross training. It is highly desirable for staff in the departments above to have the basic skills
to work in other departments as needed. Can a lab technician dispense eyewear in a pinch? Can a clinical
technician do a frame selection? Can a receptionist adjust a frame?
- Employment manuals. There is really a need for two different manuals: procedural and policy. The
policy manual discusses the rules of the office, such as sick leave and vacation time. The procedural
manual lists and describes how the duties of a job are done, like how to perform autorefraction or how
to schedule an appointment. Both are important, but reading the procedural manual tells a new employee
what to do.
- Videotape. It’s often easier to videotape a procedure being done than it is to write how to do it.
- Shadowing. This is simply a new employee following and observing a veteran counterpart all day –
for perhaps a week. Then the roles switch and the newbie does the actual work while the veteran
observes. When the new employee’s skills are deemed acceptable, he or she begins to work solo.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management