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I'm on a quest to reduce optical remakes in my practice in order to save the unnecessary expense and to improve patient service. At the core of this mission is a series of staff training sessions. Here are the steps I took to plan and implement the program.
I started by asking key staff members, like my office manager and chief optician, to tell me the most frequent errors they see by our staff in the optical department. In other words, what are the major causes for remaking optical jobs? You may intuitively know these errors yourself, but it's good to get the input from others who may be closer to it. Here are the items I found to be the biggest problems:
PD measurement. I was surprised that something so basic made the list, but we have a large staff of technicians and opticians and some are more advanced than others. Some employees needed additional training and I think even the veterans benefit from a review. The importance of the PD is elevated when we discuss it. We discussed the use of the pupilometer, the PD ruler, dotting demo lenses, parallax, orientation of the patient's face and vertical optical center measurements. We also covered the standards for Rx verification and tolerances for PDs.
Segment height. We covered our standard technique for bifocal, trifocal and progressive lenses with an emphasis on patient posture and adjusting the frame before taking the measurement. We discussed how to be sure there is enough vertical height in the frame to work well with progressives, minimum required seg heights by lens brand, and using progressive lens templates to see if the lens will cut out properly.
Frame fit. This is a general topic that covers many aspects of dispensing, including choosing a frame that works with the Rx, selecting a good shape for the face and deciding on eye size, bridge size and temple length.
Frame adjustments with care. We emphasized how to not damage the frame or lens during adjustment by using the proper tools for the job, what materials can and cannot be heated, how to properly apply heat, how to remove and reinsert lenses and how to adjust special frames like drill mounts.
Product explanation and selection. We discussed how to inform patients about the disadvantages of certain frame and lens options in order to help them select the right product and to have the proper expectations of each product. We find the best approach is to be very open about the drawbacks of products, while also emphasizing the benefits. If we sugarcoat the negatives too much, patients don't understand. We love to sell products, but our first priority is a happy patient.
What should the optician say when delivering a new pair of glasses? I like to see a brief review of the lens and frame features that were purchased and what the benefits are of each.
There are plenty of additional topics and a program like this should never end in your office. There are many topics that are not related to optical dispensing, including telephone technique, insurance verification and billing, asking for payment and pretesting skills. Just observe your routine operations and you'll get many ideas.
Who to teach
I assume there is someone in your practice who has very good skills in the targeted areas and if so, I would ask him if he would be willing to present an informal review session for his co-workers. If you have a few good people, I'd choose the one you think likes to teach and who has better communication skills. Since the program will cover many topics over several weeks, you can easily rotate the teaching duties among your staff. If you don't have a highly skilled optician on your staff, I think your first priority is to recruit and hire one.
There was once a time when the optometrist would be the de facto dispensing expert in the practice, and some still are. But it's been a long time since dispensing was truly mastered in either optometry school or practice. It's actually very desirable for optometrists to know optical dispensing even if the tasks are delegated, because it helps the OD to work with optical staff, supervise operations, solve problems and devise policies.
How to teach
I asked the instructors of the in-service sessions to keep the content very low key, informal, practical and interactive. Just tell the others how you do it. I also recommend that the instructors allow other staff to share their tips and skills and to keep the session interactive. Encourage questions.
We avoided the use of slides in favor of using actual frames, lenses and tools to demonstrate with. We literally did a show and tell.
I asked the instructor to prepare a simple handout on each topic with bullet lists of steps to take. Each employee received a handout to take notes on and save as a reference.
In addition to understanding a topic, each technician must practice the skill. We made lots of practice items available and told employees they should pair up with a co-worker during slow periods in the office and practice the measurements and adjustments. You may wish to require that each employee pass a proficiency test by a certain point in time.
Plan the logistics
Since I already hold weekly staff meetings, I simply hold the training sessions during that time. I always have the schedule blocked off with no patients on Monday morning, from 9 to 10am. The office is still open during that time and we take care of people who walk in for adjustments or other business and we answer the telephones. I usually meet with the staff in two shifts; the first with the business office and the second with opticians and technicians. Since these training sessions are geared toward the technical dispensing skills, most of the business office staff need not attend and they can handle the office needs for the whole hour.
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.