Suggestions on Staff Correction

It would be nice if employees never made any mistakes and always did a perfect job. But, we are all human, and mistakes and on-the-job errors are part and parcel of running a practice. That raises the question, what do you do when your staff err and how do you correct them? Here are some suggestions on staff correction.

As part of this overall process you must have written job descriptions and office policies that clearly delineate what tasks a person is responsible for on their job and the overall working guidelines for the office. The reason these are so important is that you use them as part of your correction procedure. Unfortunately, very few practice owners have proper job descriptions and office policies in place.

For starters, if you are in need of correcting a staff member, make sure you know of any specific disciplinary policies that you have issued so that your actions are consistent with these. For example, if your policy states that theft is an automatic discharge, you would not work up the disciplinary gradients and only reprimand someone caught stealing.

The first level of addressing correction is normally directing the staff member’s attention to whatever policy he/she violated, what was not done or what should have been done, all of which is delineated in their job description or in your written policies. Have the staff member reread the policy and/or job description. Ensure that they understand it and clear up any confusions or misunderstandings. This is usually enough to handle the first offense.

On the second offense the office manager or practice owner should review the situation with the staff member and have them sign a copy of the policy or procedure that covers what was violated as an attestation that he/she understands and agrees to the policy and/or job description. We then recommend for you to put a copy of the signed document in the personnel folder of the staff member and give a copy to the staff member to put in their staff binder. One can consider that this constitutes a warning.

On the third offense, we recommend that you do the following: give the employee a written warning, a copy of which goes in their personnel file. Sit down and discuss this situation with them; go over the fact that they’ve been corrected on this twice before; and tell them that, per office policy, continual violations could result in a suspension or dismissal.

Practice owners normally find that this type of action on a third offense either puts a stop to the problem or points out clearly that they have a real problem staff member on their hands and that proper actions, including excellent documentation, will need to be taken in order to suspend or dismiss the staff member for future violations.

What do you do with a staff member that you have corrected three times and who messes up again? You’ve already given them a written warning, discussed that continued violations could result in suspension or dismissal, but you still find them doing it again.

At this point you should check their production record (although you should have done that already as part of correcting earlier violations). Hopefully you have a simple statistical method to keep track of key production metrics for each staff member and the office as a whole so that you can monitor their productivity. If the person is an excellent producer (which is unlikely given that they keep messing up), you might consider the next step to be a suspension without pay for a certain number of days. If the person has a poor production record, dismissal may be in order.

Again, the importance of having proper office policies and job descriptions in place in order to properly deal with staff cannot be overemphasized. You can easily put yourself in a legal quagmire if you attempt to discipline staff without these in place.

We also strongly recommend that you check with a good employment attorney when you are looking at dismissing any problem employee to insure that all of your legal bases are covered.

Real Office Policy Examples and Checklist

Below is a list of items that should be included in any basic office policy or policies:

  • Patient Relations
  • Sexual Harassment
  • Orientation and Training
  • Work Hours
  • Fringe Benefits
  • Solicitation
  • Equal Opportunity Statement
  • Terms of At-Will Employment
  • Definitions of Full Time and Part Time
  • Pay Periods
  • Vacations
  • Sick Leave
  • Maternity Leave
  • Tardiness
  • Personal Time Off
  • Absenteeism
  • Staff Meetings
  • Breaks and Lunchtime
  • Unemployment Insurance
  • Problem Resolution
  • Wage and Salary Guidelines
  • Retirement Plans (if any)
  • Holidays
  • Funeral Leave
  • Leave of Absence
  • Jury Duty
  • Disciplinary Measures
  • Continuing Education
  • Workers’ Compensation Insurance
  • Health and Safety Rules
  • Appearance
  • Office Security
  • Telephone Use
  • Where to Park
  • Voting
  • Job Performance Reviews
  • Uniforms
  • Dating of Patients
  • Confidentiality of Records and Information
  • Cleanliness and Maintenance
  • Reimbursement of Expenses
  • Outside Employment


Policy is very important to establish so that the entire group understands the rules and agreements upon which the office operates. When you have good policies known and understood by all staff, you get an effective and efficient team that coordinates and cooperates at a high level.

Below are some sample policies about the subjects suggested previously. Always consult with a good employment attorney before implementing your policies to make sure that they conform with the laws of your area.

Example General Policy Introduction

Welcome to our practice. The following policies are designed to provide working guidelines for all of us. Written office policies help to:

prevent misunderstanding and lack of communication;
eliminate hasty, unrefined decisions in personnel matters;
ensure uniformity and fairness throughout the practice; and
establish the basic agreements that everyone in the office operates on.

Our practice is open to change. Changes happen as a result of internal growth, legal requirements, competitive forces or general economic conditions that affect our profession. To meet these challenges the practice reserves the right, with or without notice, to change, amend or delete any of the policies, terms, conditions and language presented in this manual. Changes in personnel policies are made after considering the mutual advantages and responsibilities of both the owner and staff. All of us need to stay aware of current policy and, as revisions are made, new pages will be given to the personnel to place in staff manuals.

Remember, your suggestions are welcome. Just notify the office manager whenever problems are encountered and wherever you think improvements can be made.

Example Harassment Policy

This practice is committed to providing a work environment free of discrimination. This policy prohibits harassment in any form, including verbal, physical, religious and sexual harassment. Any employee who believes he or she has been harassed by a co-worker, manager or agent of the practice is to immediately report any such incident to the office manager or next highest authority. We will investigate and take appropriate action.

[As harassment is a big legal issue in today’s world, we also suggest to all practice owners that a more extensive policy be written that further defines the types of harassment and the exact steps to follow should it occur. We also suggest that you check with your attorney on proper policy in this area.]

Below is a sample policy on employee classification. These classifications are important for any employer to know because they affect the type of working hours, pay, benefits and bonuses that various employees are eligible for. Some of these classifications and their accompanying benefits or restrictions can vary from state to state. Therefore, it is important that you consult with an attorney who is familiar with the employment laws in your state before implementing this type of information.

Example Employee Classification Policy

  • New Employees: this category would include those employed for less than a specified number of days, during which they are on probation.
  • Regular Full-Time Employees: this could include staff who work a minimum of 32 hours a week.
  • Regular Part-Time Employees: this would include staff who work less than the minimum required.
  • Temporary Full-Time Employees: this would cover staff who work full time but are hired for a limited specific duration.
  • Temporary Part-Time Employees: this would include staff who are hired for a limited duration and work part-time.
  • Exempt Employees: this covers staff who qualify under the Fair labor Standards Act as being exempt from overtime because they qualify as executive or professional employees. Make sure you know the exact rules and regulations on this before you exempt anyone from overtime.
  • Non-Exempt Employees: such employees are required to be paid at least minimum wage and overtime.

Example Overtime Pay Policy

Overtime pay is paid according to the Federal Fair Labor Standards Act and our state’s wage, hours and labor laws.

Exempt Employees: employees exempt from the minimum wage, overtime and time card overtime provision of the Fair Labor Standards Act do not receive overtime pay.

Non-Exempt Employees: employees not exempt from minimum wage, overtime and time card provisions of the Fair Labor Standards Act do receive overtime pay.

Overtime hours must be authorized by the office manager or owner in advance of extra hours worked or as soon as possible thereafter. Time not worked but paid for, such as vacation, holidays and sick leave will not rate or count for overtime calculation purposes.

Example Time Tracking Policy

Each staff member is individually responsible for recording work time on the attendance sheet and/or time card when reporting for work, leaving for lunch, returning from lunch and leaving at the end of the day.

The attendance sheet and/or time card is a legal document and must not be destroyed, defaced or removed from the premises. Never allow another employee to enter your time for you and vice versa.

Overtime must be authorized in advance of extra time worked or as soon as possible thereafter. Overtime, changes or omissions on the attendance card must be authorized by the office manager and initialed.

When you leave the premises, let us know. If you have to go out of the office or the building on personal business during your scheduled work hours, first, get permission from your supervisor. Then, check in and out on your attendance sheet or time card.

Whether you use the above examples or not, having written office policy is vital to the smooth operation of any practice. It is the foundation of education, training and correction in your office and can make the difference between a well oiled machine and a machine that is constantly having problems and is in need of repairs.


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Forming Office Policy

Forming Office Policy

All doctors are extremely well trained in their profession. Unfortunately, very few doctors are trained in business or employee handbook policy creation and their appropriate implementation.

Every healthcare practice is a business that provides a beneficial service to its patients and clients. The less the practice owner knows about business management, the less service he or she will be able to deliver. The more he or she knows about practice management, the more successful their practice will be.

Forming office policy is one of the most basic and important practice management tools that any owner can implement to make a more successful practice.

Why is policy so important? Why do we consider it a fundamental practice management tool? The answer is simple but important.

Policy is important because it sets up the group agreements, the rules of the game, the procedures to follow. It is usually based on what has worked and what legal guidelines are important to know and follow. Without good office policy, you get a chaotic environment because people end up making up their own policies. This results in inefficiencies and lack of teamwork.

Policy that is understood, agreed upon and adhered to will strengthen the office and provide the best means to achieve practice goals. Even those policies that are unspoken and assumed to be known should be put in writing. By putting all policies in writing, problems and confusions that could otherwise surface will be curtailed and even eliminated. Additionally, in this litigious world, having written office policies that are attested to as read and understood provides a layer of protection from potential disgruntled employees who have violated the policies.

Policy is vital to achieving teamwork, cooperation and efficient coordination in any group activity. If everyone knows the rules of the game, the game is much more easily played. These rules and procedures are outlined in office policies.

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Internal and External Marketing

There are two areas in a practice that are targeted when marketing your practice. The first is internal; the second is external.

“Internal” deals with dissemination and promotion within your practice and to already-established patients. It includes things such as:

  • In-office patient referrals
  • Reactivation of old patients through letters and calls
  • Newsletters
  • Mailings to existing patients
  • Events, such as open houses and patient appreciation events
  • “Thank you” notes for referring patients
  • Welcome-to-the-practice letters

“External” deals with locating and reaching markets outside of your practice. It includes things such as:

  • Prospecting outside of the office for new patients
  • Advertising by using direct mail, yellow pages, etc.
  • Forming referral networks with other professionals
  • Having events and/or lectures for groups within the community

When starting out on a new marketing plan it is usually smartest, easiest and most cost effective to begin with internal marketing, as you have ready access to information about your current patients. Current patients are also more valuable because they are familiar with you and your practice.

Once you have an effective internal marketing program going, you can then look at what external marketing actions you want to do to potentially increase your stream of new patients.

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Boom in Baby Boomer Eye Disease Anticipated

Optometrists Anticipate ‘Boom’ in Eye Diseases as Baby Boomers Turn 60 – Save Your Vision Month Promotes Regular Eye Exams

In a year where an estimated 2.8 million baby boomers will celebrate their 60th birthday, age-related eye diseases are becoming increasingly important health issues, according to the American Optometric Association (AOA). The AOA is reminding Americans 60 and older that early detection through a comprehensive eye exam can prevent or slow vision loss due to cataracts and other age-related eye diseases such as macular degeneration, glaucoma and diabetic retinopathy.

“Today’s 60-year-olds are more health conscious than 60-year-olds 20 years ago,” said Richard C. Edlow, O.D., American Optometric Association Information and Data Committee chair. “But being better informed about health risks, improved technology and treatment options has not necessarily translated into including regular eye examinations into their health care routine.”

The National Eye Institute estimates that over the next 30 years, the current number of blind or visually impaired Americans will double because of aging baby boomers. According to the AOA, 20.5 million people age 60 and over have cataracts, a leading cause of poor vision in the United States.

“Age-related eye diseases do not have to lead to vision loss or blindness,” Dr. Edlow said. “Some of these have no symptoms in the early stages, which is when it is most critical to help slow the progression of vision loss.”

A comprehensive eye examination provides doctors of optometry with information about the health of the eyes, and also offers indications about diseases that affect the whole body, like diabetes and hypertension.

“Many people don’t understand that even though their vision may be clear, exams can uncover changes in the eye caused by high blood pressure, diabetes, retinal disorders and glaucoma,” said Dr. Edlow. “Since there are more treatment and rehabilitation options than ever before, early detection is all the more critical.”

The American Optometric Association represents more than 34,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists provide more than two-thirds of all primary eye care in the United States and serve patients in nearly 6,500 communities across the country. In 3,500 of those communities they are the only eye doctors.

Eye Fungus Reports Increase as Cases Emerge in United States

American Optometric Association Urges Americans to Take Proper Contact Lens Precautions to Protect Against ‘Fusarium Keratitis’

Doctors of optometry from the American Optometric Association’s (AOA) Contact Lens and Cornea Section urged contact lens wearers to take proper precautions amid reports of a potentially sight-threatening eye fungus appearing in the United States with increased frequency.

U.S. health officials are on alert after a recent outbreak of severe corneal infections associated with contact lens wearers in Asia began surfacing in America. The New York State Department of Health has issued an alert in collaboration with the New Jersey Department of Health and Senior Services and the Centers for Disease Control and Prevention, acknowledging that they are investigating three cases of Fusarium keratitis, a severe corneal fungal infection that has recently been linked to soft contact lens use. Optometrists in Florida and Iowa also have reported seeing similar cases in patients.

“This recent news is cause for concern, but not for alarm,” said Jack Schaeffer, O.D. and chair-elect of the Contact Lens and Cornea Section of the AOA. “We want our patients to be aware that there is a problem out there and that the details are unfolding as we speak. We remain committed to protecting the eye health of Americans throughout this situation.”

Health officials have not yet determined whether the cases in the United States are directly related to outbreaks in Asia. Treatment for Fusarium keratitis includes anti-fungal medication. However, some patients have reportedly experienced a significant loss of vision, resulting in the need for a corneal transplant.

“We want to make sure Americans are taking the necessary precautions to protect themselves in this interim period as information becomes available,” said AOA President Richard L. Wallingford, O.D. “It is imperative that contact lens users practice safe handling of their contact lenses, are aware of any potential vision problems and alert their optometrist as they occur.”

Doctors of optometry urge anyone who experiences the following symptoms to contact their optometrist immediately:

  • Sudden blurred or fuzzy vision
  • Red and irritated eyes lasting for an unusually long period of time
  • Pain in and around the eyes
  • Increased sensitivity to light
  • Excessive eye tearing

From PR Newswire

Laser Eye Surgery and Baseball

Laser Eye Surgery Does Not Improve Major League Baseball Performance

University Researchers Find No Improvement in Offensive Performance

There has been great public interest in laser refractive eye surgery (e.g. LASIK) with many prominent sports figures advocating its benefits. Two university researchers studied the offensive performance of a dozen Major League hitters who had undergone these procedures.

The study concluded that there was no offensive benefit to undergoing the refractive surgical procedure in these players. In addition, due to the well-established risks of these elective surgical procedures, the authors conclude that players may be best served by waiting until the end of their baseball career before performing the procedure. Players at all levels may wish to reconsider their plans to undergo a refractive surgical procedure based on these findings.

Drs. Kirschen and Laby have evaluated several thousand players at the Major League and minor league levels. They have applied a rigorous scientific approach to their testing, evaluation and intervention and have gained the respect of the baseball community at large, as evidenced by frequent lectures during the Major League Baseball winter meetings. Drs. Laby and Kirschen were the first to critically describe the elite visual function of professional baseball players and have developed a “visual profile” of the typical Major League player.

Daniel M. Laby, MD, an Assistant Clinical Professor of Ophthalmology at Harvard University, and David G. Kirschen, OD, PhD, Professor of Optometry at the Southern California College of Optometry and director of the binocular vision section of the Jules Stein Eye Institute/UCLA Medical Center, have each over 14 years’ experience working with Major League Baseball teams and players in both the American and National Leagues.

From: PR Newswire

New NIH Cataract Study

NEW NIH STUDY LINKS LEAD EXPOSURE WITH
INCREASED RISK OF CATARACT

Results from a new study show that lifetime lead exposure may increase the risk of developing cataracts. Researchers found that men with high levels of lead in the tibia, the larger of the two leg bones below the knee, had a 2.5-fold increased risk for cataract, the leading cause of blindness and visual impairment.

“These results suggest that reducing exposure of the public to lead and lead compounds could lead to a significant decrease in the overall incidence of cataract,” said Kenneth Olden, Ph.D., director of the National Institute of Environmental Health Sciences.

The National Institute of Environmental Health Sciences, one of the National Institutes of Health, provided support to researchers at the Harvard School of Public Health and Brigham and Women’s Hospital for the nine-year study, which is also focusing on lead’s contribution to hypertension and impairment of kidney and cognitive function. The findings on risk of cataract are published in the December 8th issue of the Journal of the American Medical Association.

Lead is found in lead-based paint, contaminated soil, household dust, drinking water, lead crystal, and lead-glazed pottery. Following exposure to lead, the compound circulates in the bloodstream and eventually concentrates in the bone.

The Harvard researchers tested whether bone lead levels measured in both the tibia and patella, also known as the kneecap, were associated with cataract in an ongoing study of men taken from the Boston area.

“Given the strong association between tibia lead and cataract in men, we estimate that lead exposure plays a significant role in approximately 42 percent of all cataracts in this population,” said Debra Schaumberg, Sc.D., assistant professor of medicine and ophthalmology at Harvard Medical School and lead author of the study. “While lead in both the tibia and patella was associated with an increased risk of cataract, tibia lead was the best predictor of cataract in the study sample.”

According to Schaumberg, cataracts develop as a result of cumulative injury to the crystalline lens of the eye. “Lead can enter the lens, resulting in gradual injury to certain proteins present in the epithelial cells, and this eventually results in a cataract,” she said.

The Harvard researchers are among the first to use bone lead in studying the effect of lifetime lead exposure on disease risk. “The best biological marker for estimating a person’s cumulative exposure to lead is provided by skeletal lead,” said Dr. Howard Hu, professor of occupational and environmental medicine at the Harvard School of Public Health and co-author of the study.

“Since blood lead levels reflect only recent exposures, they are not likely to predict the development of age-related diseases such as cataract, which take many years to develop.”
Cataracts, a clouding of the lens resulting in a partial loss of vision, are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. Other risk factors for cataract include diabetes, smoking, long-term alcohol consumption, and prolonged exposure to ultraviolet sunlight.

“The prevention of age-related cataract remains an important public health goal,” said Schaumberg, “In addition to the obvious problems of reduced vision, the visual disability associated with cataracts can have a significant impact on the risk of falls, fractures, quality of life, and possibly even mortality.”

Survey of Optometrists

SURVEY OF OPTOMETRISTS SHOWS FINANCES AND STAFF AS MAJOR PROBLEMS AFFECTING GROWTH

In the second in a series of articles addressing surveys The Practice Solution Magazine has conducted on the optometry, veterinary and dentistry professions, we are releasing the results of the optometry survey. Our surveys are conducted one-on-one by our trained survey team with doctors all across the United States and Canada.

The benefit of doing these surveys on the phone, rather than by questionnaire, is the ability to get all the questions answered in detail. This makes the The Practice Solution Magazine survey a bit more unique as a thorough analysis can be done of the responses.

A wide diversity of practitioners was surveyed. This ranged from doctors just starting out to doctors who have practiced for over 40 years. Fifty seven percent of those surveyed are in solo practices. Seventy two percent of those surveyed have less than five staff members.

Our survey of optometrists clearly showed that staff and financial problems are what doctors consider the primary barriers affecting the expansion and viability of optometric practices. Nearly three quarters of the doctors surveyed believed those were their most serious problems. As discussed below, these two key problems are only the outward symptoms of a much more basic underlying factor.

These problems have resulted in time consumption and lost efficiency amongst 41% of respondents while 26% felt it directly affected their bottom line. Twenty two percent believed that it resulted in stress and an overworked environment

Most of the doctors surveyed stated they didn’t learn enough in graduate school to run a practice and one hundred percent wanted more business courses to be taught in graduate school. This is indicative of the overall responses that show staff issues and finances are the key problem areas.

This also addresses the true underlying reason why the great majority of our respondents experience these financial and staff management problems. Without proper business training, it is completely expected that doctors, on the whole, would be unable to truly manage staff or finances appropriately. And, thus, the above symptoms of this lack of training are so strongly evident. One doesn’t expect an untrained lay person to be able to perform the duties of a trained doctor. Likewise then, why should a person trained to be a doctor, but never trained in business management, be expected to be competent and conversant with all the issues and problems with running a business – which is what a healthcare practice is.

To rectify not gaining an adequate education in school, seventy five percent said they attend seminars, business courses, lectures and other forms of continuing education (CE). We’ve found that many doctors spend a tremendous amount of time pursuing the education they needed to receive in school.

One disturbing figure was that over one quarter of those surveyed forgo all training and attempt to learn the business side solely by trial and error. That one out of every four doctors surveyed are “managing by chance” is cause for concern. While not true in every case, a lack of pursuit of some form of practice management education is a significant contributing factor in the struggle and sometimes failure of so many practices and businesses in the first few years of operation.

The Practice Solution Magazine has already started a new evolution of surveys for optometrists and we plan on releasing the results of that in the coming year.

The rHuPH20 Enzyme

WASHINGTON /PRNewswire-FirstCall/ — Halozyme Therapeutics, Inc. a development stage biopharmaceutical company focused on the development and commercialization of recombinant human enzymes, announced that results from new preclinical studies with Halozyme’s recombinant human PH20 (rHuPH20) hyaluronidase enzyme were presented at the 2005 American Society of Cataract & Refractive Surgery (ASCRS) Symposium on Cataract, IOL and Refractive Surgery, American Society of Ophthalmic Administrators (ASOA) Congress on Ophthalmic Practice Management, and the Clinical and Surgical Staff Program in Washington, D.C.

The data were presented at the ASCRS Innovators Session by Herbert E. Kaufman, MD, Boyd Professor of Ophthalmology and Pharmacology & Experimental Therapeutics at the Louisiana State University Health Sciences Center School of Medicine in New
Orleans.

Dr. Kaufman presented preclinical safety and pharmacology animal studies demonstrating that when viscoelastic agents commonly used in cataract surgery were placed in the eyes of animals, injection of Halozyme’s rHuPH20 enzyme into the front of the eye significantly reduced the incidence and severity of intraocular pressure (IOP) rises.

Such pressure “spikes” are believed to occur when viscoelastic materials used in the surgical procedure clog up the eye’s drainage canals and prevent fluid from properly draining out of the eye, a process that can potentially result in permanently dilated pupils,
persistent glare, pain, and discomfort, and retinal and optic nerve vascular occlusion. Dr. Kaufman’s data also showed that injection of rHuPH20 into the front of the eye caused no toxicity to the corneal endothelial cells in the eye.

“These findings further support an innovative new application of the rHuPH20 enzyme and warrant further investigation,” said Gregory Frost, PhD, Halozyme’s Vice President and Chief Scientific Officer. “Minimizing surgical complications from cataract surgery could be helpful for a large number of patients, given that more than 13 million cataract surgeries are performed worldwide every year.”

Halozyme’s hyaluronidase (rHuPH20) is a highly purified, recombinant form of a naturally occurring human enzyme and is being investigated for its ability to break down hyaluronic acid (HA), the space-filling “gel”-like substance that is a major component of tissues throughout the body. The rHuPH20 enzyme can degrade most viscoelastic agents used in clinical practice and therefore could potentially be developed for use as a viscoelastic “antidote” in patients undergoing cataract surgery, in which viscoelastic
agents are used in every case to prevent damage to the cornea.