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 By Neil B. Gailmard, OD, MBA, FAAO, Editor March 15, 2006 - Tip #217 
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Delegation: The Key to Higher Income

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If I had to pick one single management strategy that is the key to success in eye care practice, it would likely be delegation to staff. Unfortunately, there are many eye doctors who still don't delegate clinical activities for a variety of well intended reasons. In consulting with clients, I find that if you don't embrace delegation early in your career, it's easy to let the technique pass you by. Doing your clinical work yourself seems innocent enough at first glance, but it invisibly causes you to miss out on your maximum earning potential and stifles practice growth. It's never too late to change to a better procedure.

Chicken or the egg?

There are probably a dozen common reasons why doctors choose to do most or all of their clinical work without assistance from an ophthalmic technician. I've heard them all, but the reasons are usually variations on a common theme that delegation will really not help much in "my particular situation." Often, the thinking is "I'll begin to delegate more when my practice becomes busy enough that it's needed." The problem is, those practices often never become "busy enough" because a small-thinking, do-it-all-myself, mentality develops. Furthermore, the practice is perceived by the public as a small player in the local eye care market and never develops strong reasons for word-of-mouth referral.

So which comes first? Does a practice delegate because it became big, or does a practice get big because it delegates? It's often the latter.

Why delegate?

Delegation is always an effective technique, even if a practice is not very busy. It always makes sense for the doctor to conserve time by not performing routine tasks in order to perform more important tasks. Those more important tasks might include examining and treating more patients, if they exist, or they might be practice management related.

The smart approach in any business organization is to have a variety of employees at various levels of training, responsibility and salary. True economy is reached when each person works at his or her highest level. The CEO of a large corporation does not deliver the interoffice mail. Of course there are practical limits to this theory in a small eye care office, especially if it is just starting up, but the smart practice owner will push for the same principle. Delegate before it seems absolutely necessary.

Develop a plan

We can look at delegation on a scale. Some practices are on the highly-delegated end and some are on the non-delegated end, with many practices somewhere in the middle. No matter where you are on the scale, you can take a step up and find ways to increase delegation.

If you are fairly new to delegation, here are some steps to consider as you design a plan.
  • Decide on the clinical procedures you would like to have performed by a staff member. You can start small and gradually add to your delegation list. See more below on specific tasks.
  • Decide who on your staff will perform these tasks and what room will be used. Ideally, there will be at least a pretest room and two exam rooms per doctor. A technician can work in one room while the doctor works in the other, greatly increasing productivity. If your staff is completely maxed out and there is no one who can accept additional duties, hire another employee.
  • Consider how to have the results recorded. Some clinical tests have paper printouts that can be taped into the chart. Some results will just be handwritten by the technician in the usual place. You may want to redesign your exam form to be technician friendly and act as a guide to the tests that should be completed.
  • You may not have to purchase any new equipment - but if you are serious about moving into delegation, consider buying one new automated instrument. It is a great investment.
Train your staff

After you have a plan, but before you get too far, hold a staff meeting to discuss and explore the idea of delegation. Some staff members resist change, but they do better if they have a hand in the development of a new idea. Start by discussing the high cost of doing business and the deep discounts required by vision plans. Explain the need to see more patients more efficiently. Increased responsibility is also a way for staff to grow in their career - which is often a complaint among eye care employees. If staff members have a worry, it may be that they will have to work harder. You may want to pledge your support as they try the new procedure and include hiring additional staff if the change is successful.

Next, show your staff how to do the tests you have selected for delegation. Have them practice on co-workers and then just jump in on real patients. Let them know that you'll be patient as they perfect the technique.

What to delegate

If you are just starting to delegate clinical procedures, consider these:
  • Visual acuities. These can be very time consuming when you consider aided, unaided, far, near, OD and OS. If you have two exam rooms, let you assistant use the one you're not in.
  • Autorefraction. A great time saver. A few minutes saved with the retinoscope on each patient makes a difference. I know the retinoscope is hard to part with for some ODs - but move on.
  • Lensometry. This can be difficult for a technician to master, but it's a huge waste of time for doctors to do this. List the steps on a cheat sheet until your staff perfects the task.
  • Stereopsis and color vision testing.
Procedures for mid-level delegation practices:
  • Visual field screening. It is best if this is a different instrument than the autoperimeter used for threshold field exams so patient flow is not interrupted.
  • Non-contact tonometry. It's easy for any technician to use and it saves a lot of time on your healthy patients. By the way, patients really don't mind the test with the new gentle puffs - they just like to talk about it.
  • Case history.
  • Blood pressure.
  • Retinal photography.
  • Corneal topography. There are topographers out there that make it easy for staff to perform topography. Do it every year on all CL wearers.
  • Insertion of diagnostic contact lenses on any patient.
More advanced delegators can consider training staff in these procedures:
  • Chairside assisting and scribing.
  • Slit lamp evaluation of contact lenses.
  • Goldmann tonometry.
  • Subjective refraction with a computerized refraction system.
  • Pachymetry.
  • Nerve fiber analysis.
  • Radiuscope measurements of unknown RGP lenses.
Consolidating patients and practicing efficiently provides time for the doctor to lead the practice, creates a busy practice image for patients and develops good work habits for staff. If you have somehow let the technique of delegating pass you by so far, now is the time to change.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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