A potentially big problem exists in many optometric practices when one employee handles a specific task and no one else knows anything about it. That situation results in two negatives for the practice: 1) the employee could resign and take her (or his) special knowledge with her, making it difficult to operate the business and 2) the employee with special knowledge can, in effect, hold the practice owner hostage, demanding raises, overtime or special treatment and using an unspoken fear of quitting as leverage. Let’s take a look at your practice, identify if this situation exists and explore remedies for it now, before a problem develops.
In any small business, it is important to have all operational procedures documented. How you do things becomes the essence of a practice procedure manual, but the vast majority of practices do not have such a document. In most cases, the office procedures just develop over time and key employees learn them and change them as needed. I believe it is a very smart goal to write a procedure manual for your practice, but this article will focus on the more immediate need of avoiding a situation where only one employee knows everything about a specific task.
Who should have backup knowledge?
The best way to protect your business operations is to have multiple people know the basics about each task. In a large practice, with many employees, it is possible to assign two or more people to each procedure through some degree of cross-training. There may be a primary staff member who does a task most of the time, but another employee who is also knowledgeable and serves a backup role. This makes your operation more efficient if work flow increases and allows work to continue even when the main staff member is on vacation or out sick.
In smaller practices, the best person to have the backup knowledge is the optometrist and practice owner. This is the only person we can be sure will remain employed in the practice and we are also certain that he or she has the best interest of the practice uppermost. Additional staff members can also serve as backup, such as an office manager, but I strongly recommend the OD learn the key elements of every aspect of the practice. If an employee quits, the OD has enough knowledge to train the replacement and provide more resources to stay up and running.
You might think you don’t know anything about billing insurance, making glasses or many other topics, but you would be surprised at how easy it is to remove the mystery around these things once you dig into them. You have the core knowledge needed and if you spend just a little time with your staff members, you can protect your practice in a pinch.
Some optometrists open their practice with a leadership style that conflicts with the doctor doing everything. Thinking big, the OD may decide to hire others to manage various aspects of the practice. I understand the thinking behind everyone working at their highest level, but as a small business owner, you leave yourself vulnerable.
Tasks that need a backup
Here is a list of office procedures that may have only one employee who knows how to handle them. The backup person does not need to be an expert in these areas, but should know the basics about what is done and have the resources (people, phone numbers, websites, manuals, etc.) to learn more, if needed. Consider how well you could manage each of the following tasks if a key employee left your employment.
Medical insurance claims and billing
Insurance credentialing updates
Compliance with regulatory issues: HIPAA, records, etc.
Vision plan authorizations, claims, and payment reconciliation
Balance the cash drawer and make bank deposit
Recall methods: confirmations, email and post card
Facebook page and practice website: administrator and passwords
A complete list of user names and passwords for every supplier and vendor
Hiring process for new employees
Training process for new employees
Scheduling of employees
Optical lab work (in office and outside labs)
How to approach the special employee
It is not unusual for an employee who has special knowledge to be somewhat reluctant to train others in the practice. We might call it protecting one’s turf. It may seem innocent enough, but I find the practice owner must become very involved to overcome this tendency. Just telling Mary to show Jane how to do some task may not do anything. Also, if Jane does not actually perform the tasks on a regular basis, she may easily forget the key elements.
I find that honesty is the best policy and it works well if the practice owner simply reserves some time in his/her schedule and meets with the employee. I would not inform the employee in advance or make a big deal out of it because it can create stress. You can say something like this: “I’d like to learn more about our process for filing claims with Medicare and medical insurance plans (or any task). I want to see if we can improve our efficiency and I also would like Jane to learn some of this as well to serve as your backup. Please walk me through an example of what you do.”
I think it is fine to expose the elephant in the room if the primary employee seems hesitant or offers excuses. You can say that for the good of the practice and in case the employee is ever out sick or on vacation, you want to understand the process.
Be sure to take notes as you learn the process. These notes become the beginning of your office procedure manual and you can share that project with the employees as well.
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.