As I write about having you pick one thing each week and make it a great part of the patient experience in your practice, I realize that you will need more time to implement changes. Of course, that is fine. You should choose the aspects of your practice that need the most work and save the others to come back to later. But, it is very smart to analyze and improve every major connection point that the patient has with your office. This week, let’s look at the eye exam.
The eye exam (and the exam lane) may be the most important part of the entire visit to the patient. After all, this is where the patient and optometrist meet and where the exam takes place. The actual skill of the doctor is what really matters most, but patients have no way to evaluate that, so they end up looking at the exam room and drawing sweeping conclusions from what they can understand. It is akin to the air passenger judging the quality of an entire airline based on his tray table being clean: not really germane, but happens all the time.
Walk into each of your exam rooms and take everything in as if you were a new patient to your office. Be objective or better than that, be hard on yourself. Look at the following aspects and take notes.
Evaluate each exam room separately. There are no excuses for a room that is used less often being less than stellar.
Is it extremely clean? Sit in the patient chair and look at the back of the phoroptor, the slit lamp table and wheel tracks on the patient’s side. Look at the all over cleanliness of the room: ceiling tiles, light fixtures, floor covering, baseboards and corners.
How does it smell? Clean and fresh?
What sounds do you hear and overhear during work hours?
Is there a lot of clutter? I don’t mean dirt, but messiness. Too much stuff on the desk or counter creates a poor impression.
Are there electrical cords hanging on the outside of walls from the acuity chart or BIO charger? Can you hide the cords in the wall or have an electrician do it?
What is the condition of the exam equipment? Does it look up to date? Is it a bad color? Do patients ever see old and torn instrument covers?
What is the general décor like? How are the side chairs, wall coverings, carpeting, wall art or diplomas? A personal item or two is fine, but most people don’t want to see too much.
Review Your Resources
The resources of your exam room include the equipment, furnishings, structure and even your staff.
A major enhancement in your exam process is the use of a scribe. Scribes allow the doctor to not have to spend precious time entering data into the EHR system. Having the doctor focus only on the patient produces a major improvement in the experience. It is impressive to patients when the doctor’s assistant is in the exam room and the exam findings are stated verbally.
Review Your Financial Investment
If your exam rooms are looking great, then you are in good shape. If not, how much of a financial investment would it take to give them a face lift? In many cases, a budget of a few thousand dollars in decorating would result in a vastly improved look. New base and wall cabinets with a new countertop and sink can create a big change. New paint on the wall and new side chairs can also be nice improvements. The exam chair could be reupholstered in a new color.
On a bigger scale, depending on your cash flow and budget, consider investing in new clinical instrumentation, such as a new chair and stand. You may also need a new phoroptor and slit lamp, or consider a digital refraction system for the ultimate wow factor. If you are still using acuity chart projectors, I strongly recommend switching to digital acuity monitors.
With the cost of flat screen monitors as low as they are, consider a very large, wall-mounted monitor for displaying retinal images and other images like topography and OCT.
Review Your Process
In addition to adding a scribe, as discussed above, consider other ways you might change the old exam routine. Try to get a fresh and honest perspective. Some ODs talk too much, often thinking that their patients love it when, in fact, they are just being polite. Could the jokes be getting stale? Could the explanation of the visual system be more than the patient wants? I’m not suggesting that patient education is not important or desired, but only that a balance is good.
Some ODs do extra tests with an effort to try to impress patients, when really a shorter visit would be even more impressive. Consider what tests are needed for all patients and which ones can be problem focused. Can you eliminate or shorten some routine tests? I assume your own standards for high quality eye care will guide you, but also keep in mind any state mandates as well as insurance plan requirements for minimum testing.
Here are few interpersonal skills to try to include with every patient:
Smile, even if you have to work at it
Shake hands; make eye contact
Talk about something not eye related at first
Use the patient’s name
Wash hands in front of patient
Explain tests as you do them
Summarize entire exam, but keep it brief and simple
Don’t give options; just recommend best
Ask: “Do you have any questions?”
Say thank you as you leave
Most of the eye exam is in the doctor’s domain, but here are a few aspects of staff training that relate:
Scribing. This is a lot to train, but the benefits are major.
Work on making the handoff efficient. If you page an optician and no one comes, it is not a good perception.
When the technician seats the patient in the exam room, it is a good practice to wipe down the phoroptor and slit lamp with an alcohol swab. Patients love to see this.
It is best if all staff members understand what happens in the eye exam and have good knowledge of common eye conditions and treatments. Review this at a staff meeting.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.