Practice Management begins in the Exam Room

To effectively run an eye care practice, many active processes, run by a variety of people have to be coordinated and constantly honed.  It is important to avoid duplication and contradiction in the process.  From Scheduling to Check-in, from Pre-Testing to Exam Room; from Contact Lenses to Optical and to Check-out.  It all has to work together.
Not to mention all the work to be done after the patient leaves to order product and to get paid.  

Where do you start?
Most practices have a set of processes that “evolve” over time.  As times change and as our practices grow, we make changes to our processes.  Sometimes a new employee comes along who “does it a little differently.” Inevitably, these small changes lead to problems in other zones because it is all connected.  In reaction, adjustments are made or breakdowns occur.  

Decrease Variation (starting in the exam room)
There are a multitude of vision tests that can be done to help us with our diagnosis and treatment plan for any given patient.  Some of these tests are typically performed by doctors, others can be delegated to staff members. All variations in technique decrease your efficiency in the exam room method.  

Some examples of exam technique variation are: 

  • Stereo testing on all patients under 17

  • Applanation tonometry if over 50

  • Pinhole if VA less than 20/60

  • Color Vision on all boys - new patients - under 10(*)

All rules of variation are put in for good, logical reasons.  The problem is that we keep adding variations without fully considering the impact on the entire exam flow.  This leads to inconsistencies and discombobulation that spills into every aspect of the practice.

There is a good argument for not performing stereo on an 84 year old, one-eyed, exotrope, (**) but I would like for you to consider the benefits of keeping the test in the routine for the sake of decreased variation.  This is an excellent exercise that should be completed by the entire team periodically to continuously refine the exam process.  

Consider your scheduling methods.  How much time is spent trying to match a particular type of patient with the corresponding slot in the schedule?  Do you instruct your team to schedule “older patients” earlier in the day because they take longer? (“Besides, they like to get up early.”)  

Consider pre-testing technique.  We all recognize that kids, contact lens wearers, glaucoma suspects, presbyopes, cataract survivors and esophores all have different needs.  But many of our patients fit into multiple categories…..then what? Sometimes more time is spent trying to decide if you need to do topography, then just doing topography.  

Consider exam room technique.  The advent of EHR has made the idea of an exam room scribe become the norm.  By always doing the same tests, in the same order makes it easier and quicker for your in-room support.  Not to mention - more accurate. Develop a system so everyone knows what everyone else is going to do.  

This is just the beginning.  
You can see where the decreased variation helps the exam flow better.  You can also see how it bleeds into other areas of the practice. After the Patient Care zone is addressed to your satisfaction - move to the Front of the House.  

(*Three variations in one)
(**I recognize that you can’t be “one-eyed” (aka monocular) AND an “exotrope” - but sometimes you just have to write things that make your point. Just imagine her prosthetic is misaligned.)