Welcome
Developing A World Class Staff
Laurie L. Sorrenson, O.D., F.A.A.O.
Austin, Texas
Laurie L. Sorrenson, O.D., F.A.A.O.
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Became owner: 04.18.95
Staff size: 12 FTE
2007 revenues: $2 million
Member: AOA, Vision
Source
• UHCO part-time practice
management faculty
• Mollie Wright Armstrong
Public Service Award, 2008
• UHCO 1985
Dr. Sorrenson and staff
Mission statement: To be the biggest and best optometric
practice in Austin because we “wow” our patients
What is the #1 problem in
optometric offices?
STAFF!!
How do I motivate my staff?
Bonus systems
• Do they work?
• Spiff (ex. $5 for every AR coat sold)?
• Team bonuses?
– Growth?
3 C’s to staff motivation*
(Cash ain’t one of ‘em!)
• Collaboration
-Must work together as a team
• Team meetings and team projects
• Content
-Products and service are worthwhile and important…
• Choice
-Autonomy in the “how.” Respect.
*Punished By Rewards:
The Trouble with Gold Stars, Incentive Plans, A's, Praise, and Other Bribes
by Alfie Kohn
The 3rd “C” = Choice (autonomy)
• A fixed dollar amount for “patient
recovery”
• Patient recovery = $ spent to fix a
problem and make a patient happy
– Track, you will be surprised
• Staff should have the ability to fix a
problem on the spot
Punished By Rewards:
The Trouble with Gold Stars, Incentive Plans, A's,
Praise, and Other Bribes
by Alfie Kohn
• Get rid of bonuses and recognition awards
• Get rid of employee evaluations: observe and
communicate on an on-going basis
• Respect, pay a good base wage
Laurie's synopsis
Pay well, pay fair…….
then
quit talking about compensation
How do I make my staff
productive?
First, does your staff know your
vision?
• Do you have open book management?
Accumulate
• How can you improve if you do not know
where you are?
– If you can’t measure it, you can’t manage it.
– If you track it, it almost ALWAYS improves!
Staff meetings
• Use all team members to manage by
statistics
– 1. Designate key statistics
SMART test
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S – specific
M – measurable
A – achievable
R - realistic
T – time table
Key statistics
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Gross sales
Receipts
Total pts – new vs. established
Revenue per patient
Production booked – do this!
Contact lens pts
Eyewear sales
Multiple pairs
Recalls – attempts and success
LVC consults, booked, performed
Telephone shopper conversion
Compare #s to last year
• Other stats:
– Annual CL supplies
– Multiple pair sales
– Molded lenses
– Izon lenses
– Optomaps and optomap %
– Optical sales/# of pairs of lenses
Set objectives
• Start with a yearly objective and work
backwards
• Set monthly goals, then weekly
• Set doctor day goals
Report
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Weekly and monthly
Do MTD and YTD
Compare to last year!
Share Expenses information
Affecting your bottom line
• Increase productivity (see more patients)
• Increase $ per patient
• Decrease expenses
Increase productivity
• See more patients
– Delegation
– Scheduling
– Optos?
Efficiency
• Analyze and improve schedule
– Consider taking a longer lunch and "bunching"
your patients in the morning and evening.
– Analyze at weekly business meeting.
Efficiencies to consider even when
first starting out
• Maximize instrumentation and delegation
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Delegate most testing
Delegate contact lens insertion
Delegate insertion and removal training
Delegate case history – you can review and add additional
comments
– Staff needs to know how long preliminary testing should
take. Keep clock facing staff.
Pagers & lighting systems
• Lighting systems
– Can notify
– Can inform where doctor is
– Info what room is available
• Pager systems
– Can notify
– Alpha-numeric can send all info
– Hand-off
Inexpensive option
• Doorbell!
– Can notify staff or notify doctor
Optos can increase efficiency
But MUST have high acceptance rate
Staff following “the procedure” is crucial
Should I get an Optos?
• Quick and dirty answer:
– If you are doing 200 compr. exams a month, it is a
NO BRAINER….
• Otherwise:
– Estimate by taking # of complete exams x 70%
(acceptance rate) x $ per optomap.
– See if it makes sense in your practice
Scribes
• WOW factor
• Efficiency
– Contact lenses
- (trial lenses, insert & removal, review of care)
– Special testing
What else can you delegate?
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Goldmann tonometry? Tonopen?
Slit lamp evaluations on routine cl patients?
Loose lens cl over refractions?
Refractions?
Pachymetry?
Special testing - SLO, Visual Fields, Topography
Worst number in business?
One!
- Duplicate positions OR
- Duplicate tasks
- Cross train positions or cross train tasks
NO TASK SHOULD ONLY BE ABLE to BE DONE by ONE
PERSON!
Training
• Train your staff
– Certification
– Continuing education
– Meetings
– One on one
• Learn by doing, not watching
– PPT presentations for each critical position
*Int J Med Inform. 2004 May;73(4):341-8.An evaluation of one-on-one advanced proficiency training in
clinicians' use of computer information systems.
Kirshner M, Salomon H, Chin H.
Remove distractions
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Lockers (cell phones, makeup, etc)
Internet access software
Consider surveillance
The "Walk Around"
4 types of practice organization
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None
Line
Functional
Matrix
Organizational structure
• Office manager concept (the line organization)
Doc
Office Manager (queen bee??)
Staff
Staff
Staff
Staff
Staff
Organizational structure
• Functional
– Separate management centers (to take care of
practice care duties)
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Front office
Clinic
Dispensary
Lab
The dreaded “It’s not my job!”
• Functional can cause overall functions of
business to be overlooked or duplicated.
• Matrix defines who coordinated overall
functions
Matrix system
• Combines management centers with business
functions.
Business functions
• Sales (sales reporting, MTD, goals)
• Marketing (marketing calendar, brochures, etc)
• Finance (chair cost, managed care plans, accounts
receivables, cost of goods)
• Patient care (procedures manual, forms, standards of
care)
• Quality control ( educations, surveys, staff
scheduling)
Management centers
• Front office Team leader __________
• Clinic
Team leader __________
• Dispensary
• Lab
Team leader __________
Team leader __________
• Other
Team leader __________
Organizational structure
Acme Vision Clinic, P.C.
Organizational Matrix
C
E
O
Quarter Number
Management
Centers
Office Administration
Clinical Care
Optical Retail Operations
Marketing
Sales
Patient Care
Finance
Quality Control
Be the CEO
• Quit giving all the answers
• You should be asking the questions!
Benefits
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Empowered, more productive, staff
Using all staff
Clarity in roles and responsibilities
More efficient overall communication and
management
– No “queen bee syndrome”
Implement systems
Position contracts (job descriptions?)
Not dependent on personality
"Franchise" Mentality?
- Consistent experiences
- Create loyal patients to your office
*E Myth Revisited by Michael Gerber
Meetings (4 types)
(Death by Meeting by Lencioni)
- Daily check-in
- Weekly tactical
- Monthly strategic (or ad hoc strategic)
- Quarterly off-site review
Having a problem with staff?
• Phrase your problem (sandwich method)
– Keep it short and simple
– Clear expectations
– End your meeting
– Document
Hiring and firing
Hire Slow…
Fire Fast!!!
Hire slow…
Be especially careful if you are desperate…
Hire personality
Personality testing
www.humanmetrics.com ($96 for 6 assessments)
Check references (and listen)
www.KnowYourStaff.com ($119 per 16 point profile)
What about "attractiveness"?
*Go with your Gut…
*"Winning" by Jack Welch
Fire fast!
• But learn your State's Labor Laws (or always
call your attorney first!)
• Is your state law "At Will"?
• No easy way
– Simple and respectful
– Have check ready
– Get key
– Beginning or end of day usually best
“Rank and yank”*
• 20-70-10
• Yank your bottom 10%
– Is it cruel? Or the right thing?
*"Winning" by Jack Welch
Uniforms?
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Matching?
How many?
Opticians?
Friday or weekend policy?
Lunches and breaks
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Work through lunch?
Close for lunch?
Schedule lunch same time?
Different times?
Staff benefits
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Benefits manual - A special welcome
What is an optometrist?
About the doctor and practice, our mission
Salary & salary reviews
Fair Labor Standards Act
Time reporting procedures
Payment, payroll deductions, total
compensation
• Profit sharing/bonus
• Salary advances and borrowing
Benefits
• Full-time, part-time employees
• Vacations/sick leave
• Holidays, leave of absence, maternity leave,
death in the family
• Social Security
• Health and life insurance
• Uniform allowance & CE allowance
• Complimentary vision and eye care
Working conditions
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Equal Opportunity
Physical Examination
Probationary Period
Working Hours
Rest Period
Smoking/Eating/Alcohol/Drugs
Hiring Relatives
Strictest Confidence
Absence or Lateness
Jury Duty
Bad Weather
Workers Compensation
Safety
Appearance
• Care of Equipment
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Sexual Harassment
Keys
Visitors
Vital Statistics
Employee theft
Resignation/Termination
Employment at Will
Confidentiality
Appendix
Family Medical Leave Act
Americans With Disabilities Act
COBRA’S Coverage Requirements
Employee theft
• "Situational ethics"
• No tolerance
• Clear policies
– (Gimmie caps, coffee cups, etc)
• Role model
– (If you cheat or lie, your staff….)
• Bookkeeper - mandatory two week vacation
*Businessweek.com
Employee theft
• #1 way of stealing?
– Cash from deposits
• Count cash morning and night with signature.
• Two people sign off on deposit
• Only the owner opens the bank statement and credit
card statements.
• Be wary of the "perfect" employee. (stays late,
always takes deposits, never takes time off)
Employee theft
• Surveillance software (30-40% of lost
productivity due to internet surfing)*
• Surveillance camera (audio)
• All employee's purchases (even if samples or
trial lenses) are written and given to CEO
(you!)
• Look at family and friend transactions
Advice from experienced ODs:
Staff
Be Friendly…
Don't be "Friends"!
Recommended reading
• E Myth Revisited by Michael Gerber
• No BS Ruthless Management of People & Profits
by Dan Kennedy
• Punished By Rewards by Alfie Kohn
• Good to Great by Jim Collins
• Death by Meeting by Patrick Lencioni
• Customer Satisfaction is Worthless, Customer
Loyalty is Priceless by Jeffrey Gitomer
To do list
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Read recommended list
Pay fair, quit talking about money then…
Concentrate on collaboration, content, choice
Delegate: consider a scribe
Remove distractions
Implement systems, not people
Educate and train
Hire slow, fire fast
“Most people have a
desire to look for the
exception instead of the
desire to become
exceptional.”
- John Maxwell
2005-1-0005
Thank you
Laurie Sorrenson, O.D., F.A.A.O.
512.918.3937
www.LakelineVision.com
Sorrenson@attglobal.net