(Eavesdropping at a major medical meeting)

Take-home message: Pay attention to what staff members are thinking. Failure to do so may mean others will inadvertently hear about the issue at hand.

Putting It In View 

When peers ask if I ever tire of traveling, I enthusiastically reply: “No way. Traveling often has the reverse effect on me that it does on others. I go to new places, talk with folks who want to learn and at the same time, I have the opportunity to learn as well.”

To me, it is a win-win situation.

What do I learn? I learn what it is your staff and mine (by default) are thinking about.

It’s called “peripheral hearing” and I acquired this talent when I worked at the hospital. Most managers have this ability if they work in a large clinic or hospital setting.

Some say it is a form of inattentiveness-being able to have a conversation with someone while listening to other conversations around you. I call it survival.

In the clinic, you have to be able to focus on multiple scenarios at once. Almost an auditory triage process so to speak.

What patient appears ill in the waiting room? Who’s getting a little too vocal regarding their wait? Who’s holding it together by a thread and is ready to let it fly at any moment?

If you can achieve this talent, you often go home at the end of the day mentally fried. Unfortunately, this skill never shuts down with me. It’s always at full radar. Not only does it work in the clinic, it really kicks in at meetings and the airport.

Meetings and classes are an excellent time to talk with your staff. Either something in the class prompts them to ask questions, or vent, or they seek out instructors to ask for opinions on issues in their clinic lives.

At the annual meeting of the American Academy of Ophthalmology (AAO) last fall in Las Vegas, there was much discussion regarding certification, Meaningful Use, micromanaging physicians, and lastly, office politics. Office politics is a continual discussion.

What's on your staff's mind?

1. Certification

1.     Certification is a big topic of confusion.

In most cases, there are two categories: those who are already certified because their office either required it or supported it as a condition of hiring, or those who have worked in your office for years and are now being made to become certified.

The second group is terrified of having to take the exam because they may have been told that if they don’t pass it, they will lose their jobs. Or, if they were not told this, they perceive that would be the outcome.

There is still a great deal of confusion on who needs to be certified.

Whether you are in ophthalmology or optometry, if you are entering lab orders/results, ultrasound testing (not IOLMaster) but definitely A and B Scans, as well as some forms of pachymetry and ocular coherence tomography, you must be “certified something” in order to comply for Meaningful Use.

This rule boggles my mind as the emphasis is on certification of the staff entering the information into the CPOE portion of the chart versus focusing the certification on the person performing the test.

Staff blames you for making them become certified. You need to educate them to Meaningful Use and ensure that they are aware of the continual changes and updates. Decreeing the need to be certified after years of telling them it wasn’t required sends a mixed message that they interpret as: “You are looking for a way to fire me.” I have had managers report that staff refuse to do certification and want help in scripting the message that they need to do this.

Educate them, encourage them, and help then get the materials they need. They can do the COA-they just haven’t taken a test in 10 years and are afraid.

2. "Meaningful Use" means nothing

2.     “Meaningful Use means nothing to me.”

Most of your staff is aware of Meaningful Use and know it is in the office, but they have no real idea of their role in it. Discuss and educate them on what their involvement is and what Meaningful Use, and their involvement, means to your practice.

In most cases, staff understands that the practice needs to be successful and compliant. While they may be aware of Meaningful Use, ICD-10 is more prevalent on their radar. They are sticklers for coding and making sure they have enough documentation to code a given code, yet they look at Meaningful Use as something that the physician must comply with and do not realize the impact they also have.

While ICD-10 and Meaningful Use intertwine in many ways, they need to be equally aware of both.

3.    They follow your lead.

I often do a question-and-answer session with attending staff after classes and will ask: “Who calls in the doctor medication orders?” I define it as handing an Rx to a patient, calling it in, E-Scribing, etc.

When I ask if they are “certified something,” their answer is: “No. The doctor says he’s overseeing everything in the office and he doesn’t care that I am certified!”

I even had one attendee report: ”We’re from North Carolina and that doesn’t pertain to us.”

Final answer is: Yes, it does.

4. Office politics

4.    Office politics.

Probably what I hear the most is:

a.     ”My doctor doesn’t like me because I am not his favorite technician.”

b.     “My manager doesn’t make the doctor’s favorite technician follow the rules because she is afraid of the doctor-but runs the rest of us with an iron fist.”

c.      “They promised me I would learn new skills so I joined. Now I realize I am on the bottom of the pile with no chance to move up unless someone dies!”

Staff is very loyal and often it takes a lot for them to talk with a stranger regarding office politics. When they feel they have no other option, they will talk. What becomes concerning to the health of your technician pool is when the talk becomes negative and derisive. If they are willing to share the office dirty laundry when they are out of town, what are they doing when they are back home and local?

5.    “Our doctor micromanages everything-it makes us a wreck.”

That one is easy. I advise the staff to listen to what is making the physician feel the need to micromanage, and stop doing it immediately. In most cases, physicians do not like to be involved in the everyday grind of triviality that most managers get to live. However, they will become involved if they perceive that their clinic world is spiraling to a place they do not want to see it going to.

Remove the issues that have them concerned, and they will return to their world of seeing patients and running their practices.

Listening to what they are not saying

Quite honestly, I learn more from my “eavesdropping” and discussion time at meetings than I do from the classes.

Then, when I return back to my world, I try to ensure that I have the bases covered in these areas of concern. Since I am a manager, just like the rest of you, I need to be a little more covert about my listening.

My biggest bit of advice it to listen to what the staff is not saying. Listen to the types of questions they are asking and try and assuage their concerns. And head off the concerns as you “hear” them.

If you don’t listen-someone with great “peripheral hearing” will certainly hear it all.

Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.