Have you ever felt that it’s easier to perform a task at your practice yourself than give the task to a staff member? Additionally, have you ever thought, “why bother to invest the time and energy into training a staff member to operate diagnostic equipment when staff turnover is so high?” If you answered “yes” to either or both these questions, consider this: Doing everything yourself is a recipe for burnout, while robbing staff members of engagement with their jobs. The latter, by the way, can prompt job resignations.

Here, I explain what, specifically, can be delegated to staff members and how to achieve success with delegation.

WHAT TO DELEGATE

Where I practice, the criterion for delegation is tasks that do not require my skillset as an OD. That is, I perform the tasks that only I can perform. Examples of these tasks are conducting the comprehensive exam, placing amniotic membranes, performing neurotoxin injections and laser resurfacing, and diagnosing dry eye disease. I rely heavily on my technicians — I typically see 28 to 32 patients per day, and I utilize four full-time equivalent technician/scribes — and train them accordingly in the following areas:

• Patient history. Where I practice, we continue to role play, contemplate, and discuss the questions to ask patients. For example, recently we added — “did your eyes start to feel dry during the pandemic?” — to determine how to best serve patients. Additionally, we utilize questionnaires to facilitate patient history information. We ensure we ask open-ended questions.
• Review of systems. Techs ask a list of questions regarding organ systems, such as the endocrine system, so I can discern any related ocular issues, such as diabetic retinopathy or dry eye disease.
• VA. Employing a standardized chart, techs can acquire data on the patient’s ability to read those letters that become smaller with every line. They also note whether the patient had difficulty with letters that “jump” or whether letters “fade in and out.”
• Chair skills. Techs perform extraocular motility testing and pupil testing, providing data for me to assess the patient’s eye movement and suspicion for retinal and neuro-ophthalmic conditions, respectively.
• Pre-testing. Where I practice, techs instill dilation drops when necessary; operate devices comprised of an autorefractor, keratometer, pupillometer, corneal topographer, and wavefront aberrometer; use a lensometer; frequency-doubling technology perimeter; widefield fundus camera; OCT to obtain data on the health of the ganglion cell complex and macula; a meibographer; and a handheld tonometer. Additionally, they perform anterior segment OCT, including central corneal clearance measurements for all scleral contact lens patients.
• Testing contingent on findings. If patients check two or more symptoms on a dry eye disease questionnaire, technicians perform matrix-Metalloproteinase-9 (MMP-9) and tear osmolarity testing. Also, if patients answer “yes” to, “Do you want your eyes to be more open?” technicians acquire a photo of the patient and offer/instill one drop of treatment for acquired blepharoptosis.
• Exam room preparation. Techs supply the exam rooms with vital dyes, funduscopy lenses, meibomian gland expression tools, and anything specific to the patient, such as an Alger brush, proparacaine, antibiotic drops, cycloplegic drops, and a bandage contact lens for a foreign body complaint. Additionally, techs load the phoropter, and display all imaging for review. I may not utilize all these items during an exam, but having them on hand, so I don’t have to go searching for them maintains practice efficiency.
• Scribing. Where I practice, the technician who works up the patient remains in the exam room to enter all pertinent information into the patient chart as I am, once again, doing only what I, as the OD, can do: examining and prescribing our treatment plan. (Regarding the latter, E-prescribing is performed by the technician.)
• Providing patient education. The scribe explains how to use prescribed medication, such as drops and nasal spray, and what to expect from a procedure, such as intense pulse light or thermal pulsation treatments. Additionally, they demonstrate contact lens insertion and removal, and assess and explain the proper fit of soft contact lens-single vision, toric and multifocal designs. Further, the scribe reviews how to properly clean and store contact lenses, and orders all specialty contact lenses based on my specifications.
• Preparing for procedures. I have a lead technician who acquires consent forms; sets up the procedure tray; prepares the patient by, for example, removing all make-up; enters/changes settings on devices, and anything else that enables me to provide the care and knowledge that I want to impart.
• Providing maintenance post-procedure. The lead technician also cleans up the patient or applies a post-treatment product, such as sunscreen, while I’m answering any other patient questions. Further, the lead technician reviews and hands out post-procedure care instructions to the patient.

Incidentally, before exiting the room, I always ask, “What questions do you have for me?” I have found that this works better than, “Do you have any questions?” It’s too easy for the patient to say “no” on the latter question. I’m very intentional about phrasing and words — this takes practice!

HOW TO ACHIEVE SUCCESS

To make delegation efforts successful, I recommend the following preparations:

• Determine the best person for the task. Don’t choose someone randomly — meaning a warm body does meet said criteria. When it comes to diagnostic equipment operation, for example, the optometrist wants the staff member who has learned device operation quickly, has acquired accurate data efficiently, and can engage with patients.
• Communicate expectations to the appointed staff member. ODs should define for the appointed staff member what success should look like when staff perform the task, to ensure they are both on the same page. This is the optometrist’s desired outcome. For example, “Performing MMP-9 and tear osmolarity testing on patients who check two or more symptoms on a dry eye disease questionnaire and having the results open for me in the exam room is how I define the successful delegation of this testing.”
• Allow for initiative. The OD should give the appointed staff member the result they want, but then let the appointed staff member figure out the “how” of achieving it. The optometrist should give them the space to do that, realizing there is more than just their way. The side effect of this can be increased job satisfaction, as the OD has trusted the appointed staff member to execute on their own.
• Praise openly and correct privately. When one of my technicians takes a great image, I always reinforce that I appreciate their effort and why. I do this in front of the patient.
• Provide training. This could occur between the optometrist and the appointed staff member, the appointed staff member and a fellow staff member who has decided to try their skillset in another area of delegation, or via webinars, videoconferencing, or directly through the device manufacturer.
• Invite feedback/questions. This is to ensure “no stone is left unturned” regarding the delegated task.
• Require practice. The optometrist should have the appointed staff member practice whatever the delegated task may be on fellow staff members until the appointed staff member is confident in their ability to complete the task according to the OD’s expectation.

FOCUS ON PATIENT CARE

Surrounding myself with a highly trained and empowered team has been a source of great joy for me and for them. For my part, I am able to spend my time digging deeper for definitive answers, discussing my patient’s concerns regarding their vision and ocular health, and prescribing — tasks that fall exclusively under the purview of the optometrist. Additionally, I suffer much less stress because my team helps me mitigate the day to day. For my teams’ part, they are engaged and satisfied with their jobs because I’ve delegated tasks to them that are crucial to exceptional patient care. I love helping my team achieve new heights, foster their confidence, and help them develop and have a career (not a job) they truly love. OM

DR. MCGEE is the founder of Precision Vision of Edmond, Okla., a boutique-style eye practice that specializes in dry eye disease, specialty contact lenses, and aesthetics. She is also the co-founder of Precision Vision of Midwest City, an MD-OD practice specializing in premium IOLs and cataract surgery. Dr. McGee was named Young Optometrist of the year in 2012 by the Oklahoma Association of Optometric Physicians. In addition, she is a faculty member of THE VISION CARE INSTITUTE, LLC, as well a member of the Johnson & Johnson Vision Care, Inc. Speakers Bureau.