Recently, one of my associates approached me, frustrated that a technician performed a macular OCT rather than a retinal nerve fiber layer scan. This was not the first technician issue we experienced, so it prompted me to remember a practice management lesson from Dr. Steve Vargo: If I have a staff member who does something wrong repeatedly after being taught properly, it’s her fault. But, if I have a staff member who performs poorly without adequate training, it’s my fault. After considering our on-boarding process, which consisted of new staff members shadowing experienced technicians, we decided staff training should be more extensive. Our associate, Dr. Gabriela Olivares, quickly stepped up, leading the creation of a multi-week intensive training, called TechTraining Academy.
The Academy consisted of two lunches a week for multiple weeks with subject matter ranging from doctor lectures (i.e. the basics of ocular anatomy and pathology) to hands-on and one-on-one practice with the technology and tests (i.e. a breakdown of how and why to use all 10 pieces of our equipment).
There are many benefits to this training: Each team member comes out using uniform language to talk about procedures and understands how each piece of equipment is used and why it may be ordered. Calling on the techniques used at TechTraining Academy, consider these five steps to roll out a new piece of technology in your office. We’re also using this system to implement our eleventh piece of equipment.
1 ORGANIZE A TRAINING PLAN
Before the first patient sits at the equipment, organize a full, dedicated training for staff. The first piece is a technical training, or how to run the test, which can be done by the device manufacturer. The second piece is for staff members to learn the background or “why” of the equipment.
For example, I want technicians to know that if a patient mentions reduced vision at night or a family history of AMD, I may recommend a test that assesses the patient’s risk of developing AMD. Sometimes, this will be covered by the representative who comes to educate staff on how to use the device. Other times, you may need to supplement the training with what your office would specifically like staff to know.
2 HAVE STAFF PRACTICE
It’s time to get hands-on. Practice will bring together all the information each technician has learned. We schedule time the day of the training and later in the week for technicians to practice.
Technicians take turns with the new technology and role play being the technician and the patient. When they feel confident in their new skills, they will see our other team members: opticians, front desk personnel and insurance department employees.
This process has the added benefit of giving first-hand patient knowledge to other members of the staff, so they can answer patient questions that may be posed to them. For example, your front desk staff will need to be well versed on how to answer questions if you plan on doing any advertisements about your new technology, as they are the ones who will be answering the phones.
After everyone else has been tested, our doctors will sit as patients. Following this hands-on training, we will likely give the technicians a written test.
Benefits/Challenges to Innovation
IF THERE IS ONE THING our practice is known for, it’s innovation and new technology, which comes with both benefits and challenges.
→ Having the most state-of-the-art clinic with which to serve our patients.
→ Giving our office the “wow” factor that patients experience.
→ The time and effort it takes to train everyone on the actual use and the language of how to discuss the procedure with patients.
→ The implementation of a new procedure without disrupting our patient flow.
→ The potential reactions of employees who are averse to change.
But with change also comes excitement and the opportunity to improve our patient care.
3 EXAMINE PATIENT FLOW
The last thing I want to do with new equipment is begin using it without considering the implications of patient flow. We have to devise a plan! When does this test get performed? Could it be done during pre-testing? Will it be done on the doctor’s request? Will patients be brought back for a medical or special testing appointment? All these questions are answered by the doctor, but need to be communicated to the staff. The device representative should have this information on hand for training, so as not to misinform staff about when the procedure will be done in your practice, as it may be different than others.
For our newest piece of equipment, the test will be done on a different day. We have a specific schedule for patients who need to come back for medical appointments that require special testing. There is one technician who is assigned to work that schedule each day. The appointments are made with time to perform the required testing and accompanied by a 15-minute block at the end on the doctor’s schedule to go over the results with the patient.
This will not be the case with all new equipment, however. Some pieces could be performed as a screen, during pre-testing or could be both, depending on the situation. For example, keratography could be used as a dry eye screening test or on a topographer after gathering the patient history, if technicians think the doctor will want the information.
4 ESTABLISH A PAYMENT PROCEDURE
One more logistic should be considered: payment. Make sure pricing is established and coding is known. Your front desk and insurance department should be aware of the new technology to ensure they are billing appropriately. For our office, this means new fee slips with CPT and ICD-10 codes.
5 HAVE STAFF CHECK-INS
This is a step that I think is often overlooked. Anytime a new process is implemented, as prepared as we think we are, there are likely to be some issues. Each staff member should know that, in a certain time period, everyone will be meeting to discuss how the process can be improved. In the scrum management style I prefer, there may be short daily check-ins per department and larger group check-ins weekly, once the equipment is being utilized. These check-ins provide a venue to bring up any bumps in the road.
For example, when we started measuring macular pigment optical density, many patients did not understand the test. This led to re-testing and frustration. The technicians who took the time to show the instructional video in advance would get better outcomes. So we made a quick fix to ensure every patient sees the video prior to testing.
Additionally, encourage your staff members to bring you a problem, and suggest a solution. My staff is aware that I will typically ask for this whenever I’m brought a problem. If your team feels like they are a part of the plan, rather than just being told what to do, they will own the process. They will want everything to go smoothly. After all, they were a part of the implementation team.
The check-ins start frequently and then can begin to spread farther as the procedural change becomes part of the routine.
By implementing the five steps mentioned above, you have an excellent chance of successfully adding a new piece of equipment. The process of adding equipment is just that — a process. Taking the time to make sure you have covered all your bases before implementation is the best way to ensure your whole team is ready and prepared for the process. Now, who’s ready for another new piece of equipment? OM