Staff Management

Training Staff in a Small Office: How to Make a Little Go a Long Way

By Miki Lyn Zilnicki, OD, FCOVD,
and Jessica Licausi, OD, FAAO, FCOVD

March 25, 2020

Training staff is daunting for any office, but it can come with added challenges for smaller practices. The smaller your staff, the more employees need to be able to do. Every specialized employee must also be able to handle general tasks like answering the phone, scheduling appointments and welcoming patients.

Our practice, which focuses on vision therapy, has been open for 4.5 years and we currently have the most staff we have ever had. For the first two years we only had one employee who did everything: reception, insurance, pretesting and even billing.

As we grew we realized we needed to transition to specialize roles in the office to maintain efficiency. Creating specialized roles, in which employees have a clear focus in their responsibilities, also can reduce employee stress and burnout.

We currently have two full-time employees and three part-time employees. Our patient-care coordinator, who handles everything from scheduling to insurances, and our senior vision therapist are our full-time employees. We also have a part-time vision therapist, a part-time optometric technician who helps with pretesting and miscellaneous work like scanning and sending records, and a part-time medical-biller.

Set Top Training Priorities
Our top priority for all staff, regardless of their specialized role, is to be able to answer phones and be able to schedule appointments. We feel strongly about creating a team environment in the office. If the phone is ringing, and our patient-care coordinator is busy, we want other staff to be able to hop in to at least triage the call.

Top priorities for our patient-care coordinator include EHR training, a good understanding of communicating our specialty-care services and being able to communicate about insurance/coverage in the office.

Top priorities for our vision therapist are having a strong understanding of the visual system, how to execute vision therapy activities and managing the vision therapy schedule.

Top priorities for our technician are being competent in pretesting and being able to manage the flow of patients in the office.

Top priorities for the medical biller include submitting claims, understanding how our EHR integrates with our clearinghouse and importing electronic payments.

Each Employee Needs Thorough Training to Begin With
We really have taken to the EMyth program that discusses creating systems so that the office staff knows exactly what is expected of them and how to perform their jobs. Some aspects of the person’s job are more important, but all things need to be done to maintain efficiency in the office and maximize everyone’s time.

We also believe strongly in fitting each employee into their own specialty niche role within the office. This allows each person to know exactly what their individual responsibilities are. That said, once an employee is comfortably trained in their specific role the next step is to introduce cross-training such as the vision therapist being able to pretest. This allows for others to jump in and help when someone is busy or out for the day.

Achieving Training Priorities
The first thing we do when we hire new staff is have them observe the flow of the office and how we function. We also have a manual for each position within the office that includes step-by-step instructions for each task. Some of the guides are basic (i.e. How to answer the phone or answers to commonly asked questions) and others are more in-depth protocols on things like our pretesting flow. Each employee that is hired begins in a “training period.” Depending on the position this period can range from 1-3 months.

Our style of teaching is very much “jump in and try.” After observing, our employees are then encouraged to perform the task while we observe them. Then we discuss what went well, what didn’t and how to improve. Even after their training period is done, we are always listening/observing and making sure that things are running efficiently. If things are not going well, we figure out a new system to get back on track.

Create Job Aids Specific to Your Practice
We have created our own, unique manuals that are specific to our office for our front-desk staff (patient-care coordinator/pretesting). Doing this is time consuming, but I recommend that it is done for every position within an OD office. It makes training new staff easier because protocols are in black and white online and in print for employees to reference. You can do this once and then just update the manuals as needed.

For our vision therapist, we do a lot of one-on-one daily training and teaching initially, then move to weekly meetings. We utilize books, resources from COVD/OEP/NORA and also go to continuing education classes to upkeep and learn new skills. We feel strongly that you need to invest in your staff so they invest in your business. Paying for classes, travel and meetings is expensive, but it is worth it in our eyes!

Institute a Trial Period for All New Employees
Regardless of position, we do a 90-day trial period. After this 90-day period we do a formal review of the employee in which we discuss their strengths, areas in which we think they can grow and future goals. We also do yearly reviews that include a list of duties that are expected, how their current roles are being performed and future goals for them to continue growing within our office.


Miki Lyn Zilnicki, OD, FCOVD, and Jessica
Licausi, OD, FAAO,
FCOVD, are co-owners of Twin Forks Optometry and Vision Therapy in Riverhead, NY.

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