Effective lay staff training at the core of practice success

An equally important concern is how you train your trainers.

Issue: May 10, 2012

ByJohn B. Pinto

I hated every minute of training, but I said, “Don’t quit.

Suffer now and live the rest of your life as a champion.”

— Muhammad Ali

My land, the power of training! Of influence! Of education!

It can bring a body up to believe anything.

— Mark Twain, A Connecticut Yankee in King Arthur’s Court

As a physician in training, you learned early the boiled-down, three-step medical training rubric: “See one, do one, teach one.” But this simplistic mantra, while adequate for über-smart and motivated students like you in med school, is insufficient guidance in your practice setting today.

While every fortunate practice has a few lay staff stars, it is unlikely that your entire support staff can learn at the same pace you did. Nor do you necessarily want to hire a receptionist or technician who is so whip-smart that they will learn their job in a week and leave your practice for graduate school in a year.

John B. Pinto

Indeed, if you reflect on your own practice setting, some of the most competent and valued support staff you employ probably took a bit longer to learn their job than you would have wished. But today, they perform their routine tasks flawlessly. And they do so without the boredom that sets in when you hire staff who are way too clever to remain year after year in the admittedly mundane patient service roles in health care.

As an intense, smart practice owner yourself, it is easy to fall into the habit of hiring people as smart as you are and letting them organically figure out how to do their job (sometimes diverging from what is efficient or best for patient care), rather than hiring less-costly, often longer-tenured “average” workers and training them to do everything your way, every time, for years.

Better training is at the heart of this. If you create systems that can reliably take a motivated, pleasant, but very average individual off the street and teach them any non-supervisory job in your office within 6 months, you will be a more effective business owner and more confident in your control over operations. You will also stop being held hostage by one staffer or another whom “we couldn’t possibly lose.”

How to train is an important enough subject in eye care that it is worth stopping for a moment and reflecting on how you train today and how that might be improved. Let’s take a few minutes this month to not only think about how you are training your staff but, more importantly perhaps, how you are training your trainers.

Set clear goals

As in surgery, the intended outcomes in business are foremost. We want to launch any business initiative with the ending clearly in mind. The more specific, the better. This operates at two levels, one wide and one narrow. Both should be easy for you to articulate based on the overall goals you have for your practice.

Your wide goals for better training might include the following:

Lower costs by hiring inexperienced staff rather than high-cost veterans.
Achieving a higher level of support staff mastery on the floor, and doing so quickly, so the doctors are freed up to see more patients.
Speeding up patient throughput in all practice stations, from the front desk to optical.
Being more attractive to less-experienced job candidates.
Improving staff tenure (staff who know their jobs well are usually happier and less likely to leave).

And here are some examples of narrow goals for training:

Reduce the tech’s workup component of the average examination from 25 minutes to 18 minutes.
Reduce the front desk’s demographics posting errors from 10% to 5% or less.
Elevate the net collection ratio (percentage of allowable charges collected) from 90% to 95% or higher.

Both the broad and narrow goals should be clear, spelled out in writing and shared with the team before you launch a formal training or retraining initiative.

Teamwork

Of course, to be successful with any new training initiative, your practice’s underlying teamwork has to be good or better. Teamwork and high morale provide the motivation to teach and learn, as well as the group cohesion to want to help everyone on the team achieve a given level of competency. Naturally, better-trained staff will tend to be more satisfied teammates and vice versa.

Cross-training is critical. You should train everyone generally and individuals specifically. Here is an example from a completely different field.

On a NASCAR pit crew, just one person is ordinarily assigned the job of jacking up the car so the tires can be changed. But everyone can handle the job. In NASCAR, one teammate’s minor error can lose the race (sound familiar?). So the specialized training regimen is obsessive.

According to Circle Track Magazine, a trade publication, one training method many teams use involves a cardboard mock-up of a racing tire and a marker pen. While on his knees, the tire changer takes the marker and touches it to the dummy lug nuts in the pattern he has to use with the air gun, just as fast as he possibly can.

This reinforces the pattern, improves concentration and gives the tire changer a significant amount of muscle memory for the next full-bore pit stop. Imagine what the same training diligence would do to shave seconds off the time it takes your tech to get a Tono-Pen reading.

Appropriate training

It is important that you understand the baseline skills of your present workers. It is not uncommon for me to see physicians presenting an advanced didactic, theoretical lecture to the technicians, when what they really need is hands-on basic training. It is best to not impose a syllabus on a workgroup, but rather, ask workers and their direct supervisors what skills would be the most helpful to transfer. This week. This month. This year.

Are you setting enough time aside for training? As general guidance, I tell clients that they should provide about 1 hour of formal training time for every 80 hours (2 weeks) worked.

Try wherever possible to provide a practice-based context for what you are trying to teach, in a way that touches the staff directly. Here is an example: “We’re going to be shifting our refraction fee from $40 to $47. We are doing this because it will put us in line with our colleagues in the area. We know that this may seem to be a big leap to you, but it has been 5 years since our last increase. And if it would help, consider this: The extra $7 we will now charge will pay for one person’s salary here in our practice. Think of that the next time you feel shy about asking patients to pay their refraction fee at checkout.”

How do you currently reward staff for their completion of each training cycle? This need not, in most settings, be a permanent advancement in title or pay, but rather some tangible, public recognition: a pin on the staff member’s name tag, a letter of recognition signed off by the owners, or a shout-out in the biweekly staff bulletin. Of course, reaching significant training hallmarks should come with more than a pat on the back. Many practices find it helpful to fractionate staffing levels (eg, Tech Level 2 or Billing Level 1) and to kick payroll ranges up a notch when a higher threshold is met.

Advance planning

Plan ahead. Rather than springing a training session on staff at the last minute, schedule these sessions in advance throughout the year. Reduce anxiety. Let staff know what each training session will involve. Train the trainers. Be sure to train billing supervisors, front desk leads and head techs before you train their staff so they know what is coming around the bend for their staff, so they can be a role model for those below them.

Try to have your supervisors supply readings and self-assessments to their staff several days before you start a training session. This will prepare your staff for what is coming, as well as save time on routine information, get all the students up to speed on the same basics and set the right tone for your supervisors’ role in a given training module.

Finally, there is little business purpose in overtraining or paying people for learning skills that are not directly relevant to their current position. Every practice needs a certain number of junior-level, COA or lower techs, because not all jobs oblige high-level skills. It is pointless, at least in dry business terms, to insist that all of your technicians gain COT designation or that every tech learn to be a surgical scrub.

For more information:

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; Legal Issues in Ophthalmology: A Review for Surgeons and Administrators; and Leadership: A Practical Guide for Physicians, Administrators and Teams. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.