welcome. developing a world class staff laurie l. sorrenson, o.d., f.a.a.o. austin, texas

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.

• 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 optometricpractice 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

• S – specific• M – measurable• A – achievable• R - realistic• T – time table

Key statistics

• 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

• 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– 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?

• 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

• Lockers (cell phones, makeup, etc)• Internet access software• Consider surveillance• The "Walk Around"

4 types of practice organization

• 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)• 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 Team leader __________ • Lab Team leader __________

• Other Team leader __________

Organizational structure

Be the CEO

• Quit giving all the answers• You should be asking the questions!

Benefits

• 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 testingwww.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?

• Matching?• How many?• Opticians?• Friday or weekend policy?

Lunches and breaks

• Work through lunch?• Close for lunch?• Schedule lunch same time?• Different times?

Staff benefits• 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• 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• 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• 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.comSorrenson@attglobal.net