In our ongoing series of tips about the patient experience, the next point of contact (also called influence points or moments of truth) for a typical eye exam is pretesting. When I first opened my practice (cold), I did my own pretesting. I suppose it was not technically PREtesting because the doctor was doing it, but you get the idea. I thought how cool it would be if I had a dedicated clinical technician who could do some of the data collection with automated instruments before I saw the patient. Even cooler would be that the tech could be pretesting one patient at the same time I was examining another. All I needed was enough cash flow to hire another employee, buy some automated instruments and, of course, I needed much more patient demand if we were going to see two patients at the same time.
Fortunately, things progressed along and my practice was able to implement full usage of the pretesting concept. In the early days, I thought the more pretesting we could do, the more impressive our practice would be to the patient. But, I eventually realized that there is a limit to how much technology and wow factor a patient needs in order to be impressed. Eventually, it just becomes another chin rest in what may seem like a never-ending line of them. There is also a need to speed up the eye exam process; not only to achieve more production in a business sense, but also because patients have busy lives and they don’t want to spend a long time at the eye doctor’s office.
Read on for ideas on how to analyze your pretesting process.
Here are some questions that will help you evaluate your current pretesting process:
What tests are included in a comprehensive eye exam in your office?
What clinical testing do you currently delegate to technicians and what tests could you delegate? Make two lists and include everything (case history, acuity, cover testing, tonometry, field screening, etc.).
How long does pretesting currently take, on average? Might you have too many pretest procedures?
What additional tests or instruments would you like to add?
What rooms are used for pretesting and are the tables, chairs and instruments comfortable and secure for people of all ages and sizes?
What is the general appearance of the pretest rooms and are they extremely clean?
What do technicians usually say to the patient as they perform pretesting?
Review Your Resources
Consider the following aspects of your pretesting process:
Networking and imaging. Are some of your devices in the pretest room connected via your computer network to all the exam rooms? Allowing patients to see the images of their retina or cornea that were captured earlier, with the doctor providing some commentary on them, is a very powerful wow factor.
Integration with EHR. Having data flow seamlessly into the clinical record is very efficient and eliminates errors.
Enough staff? Starting the pretest process quickly is a big advantage to your practice. Consider training your pretester to also become a scribe. This requires more staff, but it allows you to see more patients with no more work.
If you have multiple doctors in your practice, do one pretest room and one set of instruments serve your needs? Is there often a bottleneck at the pretesting room with technicians waiting to gain access?
Review Your Financial Investment
Many of the resources listed above relate to the financial investment needed in pretesting. Make your own wish list of instruments, office space and layout and staff. Begin to invest in this area of your practice each year. The return on investment will be extremely good; much better than any stocks or bonds.
Review Your Process
Since pretesting is generally handled completely by staff members in private areas, it is hard to supervise it. When that happens, it is very common for the process to change from the original vision the OD/owner had in mind. Over time and as one staff member trains a new one, who trains another new one, the verbiage and testing methods can change. Talk with your staff openly about what they do and say in pretesting. Be on the lookout for these issues:
Do you offer a screening test in pretesting, such as retinal imaging? If so, could the patient feel pressured to opt for the test? Can patients say no, gracefully?
Are techs asking the same question over and over, instead of reading the chart? It is extremely annoying to answer questions about allergies or the chief reason for the visit three or four times in the same visit.
Is there a lot of wasted time waiting for the next room in the exam process? Is there often a long wait for the doctor when pretesting is done?
Meet with your staff and discuss pretesting from the patient’s point of view. Set aside what works best for your team or your office and try to change your process to meet the wants and needs of the patient.
Work with your staff to write sample scripts that go with each pretest procedure. What are some common questions patients bring up and how should they be addressed? Try to work in some statements about the importance of recall and regular eye care. Also, use the opportunity to educate patients about the best eye care and the doctor’s skills.
Block some time in your schedule to teach your staff how to perform some new delegated procedures, such as pupil testing, confrontation fields and cover test. Provide some basic background about ocular anatomy and physiology and why those tests are important.
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.