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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 30, 2012 - Tip #535 
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Your Staff: Cross-Train or Departmentalize?

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As you analyze and refine your practice operations, consider the job descriptions of your staff. Is it better to cross-train your staff or to assign staff to more specific job duties? How you decide on this can make a huge difference in your practice efficiency and on patient satisfaction.

Your practice in phases
The answer to my question is not as easy as you might think at first. I look at the optometric practice in phases and I believe the best staffing strategy varies depending on the phase. I've been through all these phases in my practice and here is the model I followed at different times:

  • Early growth phase. This practice has a small staff and they are generally all cross-trained. Everyone does everything and that serves the practice well at this stage. Even the doctor handles tasks that will eventually be too basic, but at this early stage, the staff is not trained at a very high level. The role of the staff member may best be described as an optometric assistant. The assistant answers the phone, greets patients, and performs basic pretesting and simple optical dispensing. Anything more complex is handled by the doctor.
  • Need for accuracy. As the practice grows, there is a need for staff to function at a higher level and it becomes difficult for each assistant to learn everything well. If a larger staff tries to do everything, more errors are made and it is hard to track down who is accountable. A logical strategy is to make the staff more specialized. Some employees are opticians, some are receptionists and some assist the doctor with clinical care. Having some employees specially trained to do specific tasks helps them to do a better job.
  • Expansion and delegation. With more delegation and new technology, there is a need for even more specialization. The practice may add an in-office finishing lab. There is a need for a dedicated insurance coordinator. The practice may begin to use scribes. Technicians could be trained to refract.
  • Full circle. In larger practices that are highly delegated, there may be very busy times that are highly productive and other times that are relatively slow. This change in demand may be random or due to other factors like one or more doctors taking time off. The larger patient volume can cause the optical dispensary to get very busy at certain times when people drop in without an appointment. This phase of practice has many employees who are well-trained in specific duties, but they can also be cross-trained to perform other jobs fairly easily. In my practice, for example, all the clinical technicians are also scribes and opticians. This gives us great flexibility to put staff where they are needed. They can handle a heavy load in the clinic or a busy rush to pick up glasses or select frames in optical. We also train our lab technicians (whose main job is making glasses) to dispense eyewear to patients. Our insurance coordinator and a couple of specially trained clinical technicians can help out at the front desk when needed.

Here are some typical departments to consider as your practice moves through the growth phases.

  • Business Office
  • Clinic
  • Optical Dispensary
  • Optical Laboratory

In addition to these departments, other special areas include: contact lens department, insurance department, office manager, frame buyer, and marketing specialist.

The formation of departments can happen gradually, with staff learning advanced techniques in specific areas over time. As new employees are hired, the department of need is identified and candidates with appropriate skills and experiences are recruited.

When these departments grow to include more staff, it may make sense to appoint a department manager. Typically, there is already a general office manager in place at this point, and the practice can benefit from a group of assistant managers who can fill in when the general manager is off work or busy with other matters. The practice may have extended office hours and need supervision at times and the department manager can become an assistant manager. This approach also recognizes strong contributions from staff members who have performed well by promoting them.

One of the disadvantages of departments is there can be some competition and lack of cooperation between staff members in different areas. Usually this is not a problem if the practice has developed a culture of teamwork and fosters mutual respect among coworkers.

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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