I presented a webinar last night on the topic of scribes and supertechs. There was a lot of interest and some excellent questions, so I’ll continue to write and lecture on this topic. Many of the questions revolved around how to motivate staff members to want to take on this task and how to train them.
Three ways to implement scribing
There are three different ways you can approach the staff assignment to scribing:
A dedicated scribe. This staff member should be proficient with keyboarding and also have some knowledge of medical and optical terminology, but she does not need to be a clinical technician. Each working doctor would have one scribe.
A pre-tester who is also a scribe. This is a natural extension for the clinical technician who already knows a lot about eye care. The practice would need at least two of these per working doctor because one needs to be working up the next patient while the first one is recording for the doctor.
A supertech, which I define as a pre-tester who is also a scribe and also an optician. This highly cross-trained individual can stay with the patient from the beginning to the end of the visit and the patient is never left alone. There is a seamless transition from the exam room to optical with no searching or waiting for an optician.
The first two job descriptions would still require a handoff to an optician for frame selection and lens design, while the third one does not.
Any of these three methods will work well and you should consider which one will work best for your practice and with your staff. You may want to start with one system and transition to a different one as more staff are hired.
Staff needs leadership
Leadership is an intangible skill that is hard to describe, but we all know it when we see it. Staff members frequently resist change and the best way I’ve found to overcome this is by respecting them and being honest with them. If you would like your staff to embrace the concept of scribing, have a staff meeting and explain to them why you believe it would benefit your practice. Don’t be afraid to discuss the business aspect of the practice, such as the need to generate a greater profit which may involve seeing more patients per day.
Also, be sure to discuss how EHR software is not actually faster than paper, and it requires a large amount of time to enter the data. Explain how the patient experience suffers when the doctor spends most of the time typing, clicking and searching drop-down lists. Discuss how efficient it would be to have a scribe in the exam room.
It is important to look at the new task of scribing from the employee’s point of view. Some staff may be concerned that they will have to work harder with this new task, or that they may not be able to master it. Once you understand the fears that staff may have, you can overcome them by pledging resources (such as hiring more staff) or by promising plenty of time for training and that you can do a trial run first.
Opportunity for career advancement
As you encourage your staff about the idea of scribing, get them to see the project as an opportunity for career advancement. I don’t think it is necessary to be specific about raises at the outset of this process, but it is understood that as new skills are learned, raises will occur. In some cases, careers in optometric assisting have not had enough opportunities for career growth, but new responsibilities are just that.
Also realize that you may learn something about an employee that you did not know. You may find that an employee who you thought was excellent is really not much of a team player and does not support your vision for the practice. That does not mean the employee does not have other good traits, but this is new information that enters into your ongoing review process.
When you are first starting out with scribing, it is best for the doctor to train the first few scribes. Start with a pilot program. Work with your best technician and show her your EHR software or your paper exam forms. She most likely already knows quite a bit about these documents, but review some previous records with her and show her when you free-form type and when you use drop down lists. Tell her the most common things you will say out loud when you scribe. Then have her sit in on a few exams and record the results as you speak.
Keep in mind that it is perfectly fine for the doctor to still make some notes (on paper or in the software) and the patient will not think anything of it. The doctor does not have to say everything out loud if it is sensitive information or if it would upset the patient. After the exam, review the record with the scribe and consider how the process could be improved. Implement changes that will make the experience better.
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.