Techniques Monthly Electronic Newsletter
May 2010

Evaluating the Performance of Your Techs
Jane T. Shuman, COT, COE, OCS

Annual evaluations are critical for measuring the performance of your clinical technicians. Regular evaluation helps define your practice’s performance standards in accurate and measurable terms and weed out performance behaviors that do not meet those standards. Evaluations are also vital in addressing the techs’ learning needs and linking their performance to the overall performance goals and objectives of the practice.

In this article, I will describe the clinical and nonclinical areas you should assess, examine methods that will capture and convey clear and practical performance data, and answer the question of how you can evaluate technical personnel when you are not yourself a tech.

Clinical Performance

Clinical performance must, of course, be considered when preparing the annual reviews of your clinical staff members. If you, like many administrators, do not have a clinical background, how do you accomplish this goal when techs work one-on-one with your patients behind closed doors? The key here is to get feedback from those who are in a position to evaluate their work: physicians, lead and other techs, and patients. I’ll go into this further toward the end of the article; for now the important thing is to know that evaluation is not a one-man job.

Standardizing the tech role is a critical first step in the process of evaluating techs’ performance. Keep in mind that physicians rely on the information provided by their techs. They expect all staff to perform the components of the workup consistently and according to a set of procedures or standards.
 
The clinical supervisor then, needs to have a way to objectively evaluate the skills of his or her staff. Here is an example of a form you can use for such an evaluation. It is best to perform the clinical skills evaluation at regular intervals — quarterly, biannually or annually — to provide consistent and accurate performance data.

I recommend evaluating four clinical components as part of your annual tech evaluation. These are: 

1. Technique
2. Accuracy
3. Efficiency
4. Understanding

Technique
For an experienced tech, the process of evaluating clinical skills begins when being considered for a position. I have found there is a wide of variety in the techniques used to perform the same tests; therefore, it is critical that atypical methods be detected early on so that the tech can be trained in your practice’s procedures once the tech is hired. At the same time, the expectation should be set that the clinical leader or practice trainer will spot check the new hire during and after the probationary period.

Because the supply of ophthalmic techs does not meet demand, many practices are relegated to hiring inexperienced techs. However, when the amount of training is insufficient the tech will be unjustly penalized for poor technique.

Accuracy
The ophthalmologist has the assumption that every member of his or her staff is providing reliable data based on the consistency of technique among them. In other words, every technician is performing each skill in the same manner as one another; the best way to assess this is to have a senior person (i.e. clinical leader, staff optometrist or physician) shadow the techs during patient exams. This can serve as an opportunity to review proper technique with all clinical staff.

In addition to the accuracy of skills performance, it is important for the physician and the senior technician to evaluate the technician on comprehension and efficiency as well since these are often the factors that enhance the patient’s perception of the visit and help drive patient satisfaction rates up or down.

Efficiency
To conduct a fair and meaningful performance evaluation it is good practice to utilize quantitative measures to evaluate efficiency. This can be accomplished by giving a numerical rating to each of the performance measures on the competency form and then monitoring these ratings over a period of time.

This sort of a time study may be conducted with or without the active engagement of your staff. The numerical rating on the performance can be enhanced with notes in case of peculiar situations e.g. when a workup takes longer than the expected average time, there are notes added to explain why. For instance, “patient had 3 pairs of glasses”, “had to use the rest room” or “the patient is on a walker/in a wheelchair”. Overtime, this data will provide a complete picture of the techs overall performance.

At the conclusion of the formal study, consider continuing compiling data without their participation. You may only have the start and end times, but if your techs are working consistently, it is expected they will workup the same average number of patients per hour as they did during the announced time study. If they are unable to perform at the same level, this indicates that efficiency needs to be addressed.

Although it will be difficult to know what exactly is taking them longer with some research, you may be able to identify the bottleneck. For instance, you may want to determine if they are taking too long with each patient, or finding something to do between seeing patients such as inventory, prescription refills, coffee breaks etc. Frequent walks through the clinical area may offer some insight here.

Understanding
Understanding is an important criterion of evaluation as it ensures that doctor requirements, tech performance, practice and patients’ needs are all being addressed in a consistent manner. 

• Techs should have a clear understanding of the doctor’s requirements
• Doctors should be able to clearly understand the information provided by the techs.
• Techs should be able to clearly communicate with patients and procure the necessary information for the doctors.
• Techs should be able to balance attending to patient needs with the overall practice goals.

It is important that all techs have clear comprehension of the tasks performed, including the implications of a negative finding and know how to proceed should that occur.

Nonclinical Evaluation Parameters

It is also important to observe your techs’ performance and behavior outside as well as inside the clinical arena. This information will provide you with a broader picture of each tech’s participation within the practice as a whole. Just as you have non-task criteria by which you review your office staff, nonclinical criteria should be used when reviewing your clinical staff, including such areas as:

• Teamwork (helping other in areas of the office: filing, answering phones, etc.)
• Meeting and exceeding patient needsMeeting and exceeding patient needs
• Offering to arrive early, stay late as necessary
• Taking initiative
• Motivation to find online and other sources to continue clinical education
• Punctuality

The Evaluation Process

All physicians and the clinical leader should be part of the review process, since they are best positioned to evaluate the accuracy of the work. Rather than providing them with the evaluation form in the months prior to the review, consider logging examples of poor (or exceptional) workups throughout the year. These instances should be discussed, and conversations documented so progress can be tracked. If similar cases arise during the year (e.g., missed papillary defects after remedial instruction has been provided) disciplinary action may be appropriate. Remuneration could potentially be discussed during the review process, or it could be part of an annual merit review or at the end of a probationary period, depending on the practice policy.

A 360-Degree Review

Depending on how much input you want for your reviews and the size of your practice, you may want to consider what is called a “360-degree” review process. In this scenario, employees are asked to provide comments on their peers. (In large practices, the administrator may solicit feedback from only selected employees.) In a small office such a review may be more difficult; however, if reviewers’ anonymity is assured and no comments are handwritten, the feedback may be valuable.

Such 360-degree reviews usually include a self-assessment and, in some cases, feedback from external sources — in this case, patients. Rather than formally requesting feedback from the patients, I recommend collecting unsolicited feedback throughout the year, both positive and negative.

Goal Planning

Skill oriented goals for the following review period should be set by mutual agreement. Continuing education opportunities suggested by the manager are typically intended to improve the tech’s performance and understanding of the tasks he or she provides. Those suggested by the employee often stem from a personal interest. Studies have shown that when employees are personally vested in a job, the outcome is better than when they are not.

According to Carter McNamara, MBA, PhD: of Authenticity Consulting:

Self-directed learning becomes even more powerful when it's systematic, that is, when we decide: 

1. What areas of knowledge and skills we need to gain in order to get something done (our learning needs and goals)
2. How we will gain the knowledge and skills (our learning objectives and activities)
3. How we will know that we've gained the areas of knowledge and skills (learning evaluation)

One goal that will benefit the employee, the practice and, most importantly, the patients, is attaining certification or additional certification before the next review. For example, Certified Ophthalmic Assistants (COA) should be encouraged to seek the next level of JCAHPO certification, Certified Ophthalmic Technician (COT).

Conclusion

Managers need to use multiple yardsticks to fairly assess their clinical staff. Gone are the days of simply asking the doctor to evaluate each tech. Feedback from multiple sources will often provide a better, more complete picture so that the technician can be rated using objective criteria, as are your billers and reception staff.


About the author: Jane T. Shuman, COT, COE, OCS is president of Eyetechs, a national consulting firm on clinical flow and efficiency, scheduling, and technician training. She has been a frequent presenter at the annual meeting of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgeons. She is also the course director of the Allied Health Track of the Hawaiian Eye Meeting.

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