A: Delegation is what can make a “good” practice an “exceptional” practice, and I don’t just mean in terms of revenue. I’m constantly reading, searching and talking to all sorts of healthcare professionals about how they delegate work in their practices. In essence, I want to do the things within my business that I enjoy and delegate the items that make me inefficient, I’m not adept at or I just don’t want to do. This has benefits for me, my practice and my patients.

Here, I’ll discuss two example practices before talking about what tasks to delegate and, finally, how to know whether the delegation is effective.

HOW DELEGATING PLAYS OUT

Take Practice A and Practice B. These two practices actually exist, and are based on my own observations and conversations with both owner doctors. Both were cold-start practices, opening about a year apart. Practice A was first; it opened in a booming bedroom community that had moderate competition. Practice B opened a year later and, although there was no immediate competition, this outlying suburb was smaller than Practice A’s location.

Throughout years one and two, both practices progressed at about the same rate. The divide started to widen, though, in terms of staff, delegation, doctor time and technology investment after year two. Specifically, Practice B started to re-invest money into technology that allowed for additional revenue streams. At the same time, the doctor at Practice B was able to hire more staff to delegate pre-testing and administrative activities. As a result, Practice B was able to begin seeing even more patients, and was producing at a higher revenue per patient than before, which allowed it to acquire further technology and staff investments over the next seven years. All the while, Practice A tried to keep a tight rein on staff expenses, only allowing one or two key staff members to work in the practice, while the doctor continued to do much of the technology operation and wear many hats.

In addition, the doctor at Practice A was seeing patients five days per week throughout this entire time period, while the doctor at Practice B was seeing patients only three days per week. With increased delegation, though, Practice B’s doctor was seeing the same number of patients as Practice A, but in less time. As Practice B continued to grow, it outpaced Practice A and had to hire more staff and an additional doctor. The doctor at Practice B wanted to maintain her three-day per week schedule, and was able to pay herself more than the doctor at Practice A, as she continued to work on her practice and its systems, what services it offered and staff delegation.

This example shows the beneficial effects delegation can have on practice, specifically to take it to the next level or, at minimum, make your job and day-to-day much easier, all the while being profitable.

WHAT TO DELEGATE

There are key areas practice owners can delegate:

1. Patient care. Pre-testing the patient prior to the exam, gathering an updated history and uploading testing data to the EHR are examples of these duties. Higher-level delegation may include scribing during the exam, refracting the patient (if able to, based on state laws) and performing contact lens fittings.
   At my practice, I started using a technician when patient demand dictated it — I was starting to book up a couple weeks out — and slowly built in the higher-level delegation skills, as the employee showed aptitude via the ability to pre-test, run the equipment and work closely with patients and technology. I hired specifically for this position, knowing that, in downtime, this technician would be working on administrative work with contact lens orders and patient communication. Today, my staff gives various in-practice treatments to patients, and contact lens checks are performed by staff, when necessary.
   Optical work also counts in here. I’m often surprised to hear of how many doctors will sell glasses or adjust their patients’ spectacles. Monetarily, this is not the best use of an O.D.’s time, as we can do more by seeing multiple patients while an optician is managing the sale of glasses.
2. Administrative work/human resources (HR). This encompasses hiring, reviews, scheduling, HR counseling, benefits, work, billing insurances, etc. Options for delegating these tasks include hiring staff, but also outsourcing to a company, such as a local or national hiring agency, that specializes in these tasks. Outsourcing has the advantage of mass efficiency and lower cost to the practice owner. Additionally, terminating the service is much easier than firing a staff member.
3. Specialized services. Expanding staff into niche areas, such as vision therapy, sports vision training, expanded DED services or myopia control, requires more training, but these “counselors,” as we refer to them in my practice, are knowledgeable in each niche area and, therefore, able to save me time in regard to specialized testing, treatments and answering patient questions.
   I first offer these positions internally when looking to expand services, as I want someone first and foremost who’s interested in the niche. Then, we train them and get them on board. The benefit: I now have staff who are cross-trained to do several jobs/duties in my office. This gives me more flexibility if staff are absent for any reason.

HOW TO GAUGE EFFICIENCY

After delegation takes place, how do you know whether it’s effective? There are three key areas I look at when analyzing changes:

1. Ability to expand patient care and financially grow. This is measurable via an increase in patients per week and expansion of services. If I am able to do this, revenue follows and, usually, more than justifies adding a staff member.
2. Gauging staff stress/workload. I run annual reviews, as well as a mid-year check-in, with staff. I’m paying attention in-between, of course, but these two times are my main touch points to see how staff is faring in regard to workload. By delegating, my observations are that staff is busy, but not overloaded to the point that patient care is affected.
3. My sanity. This key indicator is huge for me. Delegation should allow me some breathing room in my day-to-day job. I don’t want to be slammed and stressed and running around trying to get everything done. If I can step away from the patient, or practice, and I know that things are going to run smoothly in my absence due to delegation, that is a big positive. I can tell as soon as my workload increases that hiring, or expanding duties, may be on the table.

BREATHING ROOM

Perhaps you are looking to make a big step in your practice growth, or are simply looking for some breathing room. Delegation is the key to scaling. Resources I’ve used to help me understand how to best to delegate include Neil Gailmard’s “Tip of the Week” articles, when I first started practice (Archives for this can be found at bit.ly/TOTWsubscribe ), and many business books, including the “The E-myth,” by Michael Gerber, as well as “Clockwork: Design Your Business to Run Itself,” by Mike Michaelowicz. O.D.s should note what jobs they want off their plates, conduct research and plan. Delegation is meant to make life easier and more profitable, so employ and enjoy. OM

DR. WESLEY practices at Complete Eye Care of Medina, a Vision Source practice, which she opened in 2008. She was honored as Minnesota’s Optometrist of the Year in 2011. Email drwesley@cecofmedina.com.