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Random thoughts at 3 a.m.


What keeps everyone up at night? Disillusionment with continual change


Disillusionment with continual change seems to be a common thread in recent conversations with technicians, managers, and staff, relates Dianna Graves. The changes keep coming: Compliance, Meaningful Use, EMR, ICD-10, and HIPAA.


Putting It In View By Dianna E. Graves, COMT, BS Ed

Minnesotans patiently wait through 6 months of winter for spring to arrive. This year, it would be more appropriate to call it “Pseudo spring.” We didn’t have much of a winter by Twin Cities’ standards, only to find ourselves in April deep in a resurgence of winter trying to make a late comeback.

We had put the patio table out a few weekends ago-hoping it would convince the snow gods to give up winter’s grip and spare the snow blower one more experience.

At 3 a.m., I am sitting at the patio table, with my snow jacket on, staring at the stars and thinking.

Having just returned from the annual meeting of the American Society of Cataract and Refractive Surgery and sunny San Francisco, I am recounting conversations I had with many fellow technicians and managers, as well as my own staff that were home manning the fort. Through it all, the take-home message I heard repeatedly was: disillusionment with continual change.

There’s so much tumult in our field right now. The changes come so frequently. We find ourselves scurrying to get most jobs done enough to stay under the radar. But, the changes keep coming: Compliance, Meaningful Use, EMR, ICD-10, and HIPAA.

Before we prided ourselves by crossing all the “t”s and dotting all the “i”s to ensure the group was “protected”-and now we don’t even know what that is anymore! An error in understanding one of myriad rules and/or regulations that before might have caused a ripple of concern is now viewed as potentially catastrophic to a group’s bottom line and confidence to continue to grow into the future.

What’s on everyone’s mind?

The conversations that bounce back into memory don’t vary much from state to state or even country to country. I found myself visiting with two managers from Peru discussing their staff dissatisfaction with each other. They were wearily describing their roles as more referees than managers. While they were talking, I thought: “This is what I was just discussing with a doctor from Illinois.”

Another discussion arose with another manager while reviewing the schedules of available courses. I saw a great course title: “It’s not you . . . it’s me!”

Sorry, but what I am hearing loud and clear from many camps is: “No way it’s me-It’s all YOU!”

I spoke to one manager who had worked with a physician for more than 20 years, and with sadness had been witnessing a downward spiral from most-beloved doctor to the physician with which no one wanted to work. It had escalated to the point that some technicians were threatening to leave the practice because it was too stressful.

She tried subtle hints, but there were no changes in behavior at all because the physician didn’t seem to have a clue that it was actually his/her behavior that the manager was talking about. Nodding knowingly, I asked her how/when she had found peace with this behavior.

She sadly smiled and said, “It’ll be okay. Wednesday, when I get home, I am resigning.”

That’s not really peace-it’s an escape. Which I guess could be described as a form of peace after all.

I’d love to say I was shocked-but I really wasn’t. After a while, the Kool-Aid doesn’t taste as good as it used to.

‘People’ first

Explaining why things are the way they are doesn’t work if you don’t believe in what you are saying. Managers take it very seriously when we consider the “people” part of the organization-not the staff or the patients, but the people.

Staff know, and often expect, that some of the formalities, niceties, and courtesies often get waived when at work-especially in the medical field. You really do need that third layer of skin! Staff know this, but they are “people” first; even though they know it, they don’t like it.

I made a comment in one class that technicians don’t like the front desk and the front desk doesn’t like the technicians. Everyone smiled, laughed, and agreed. This was a class loaded with people from all over the country.

Too much change, too fast

Where is this prevalence of dislike and unhappiness coming from? Change! Too much, too fast.

Example: Electronic medical records are a great thought. Interconnectivity to patient records to ensure continuity of care no matter where you are in the world leads to safer, quality patient care.

But it has been pushed through too quickly, and we are now seeing multiple problems with this thought.

Technicians get bogged down with overwhelming “drop-down” and “point-and-click” software menus. Physicians have to change their practice styles and focus on checking all the boxes versus providing personal attention to the patient. Clinics have to cut the number of patients they could see to accommodate the computer. With those self-imposed cuts, we now are seeing reimbursements decreased. When this occurs, offices are going to need to find a way to increase patient volume to survive-even if the system can’t handle it.

Push the staff-push the physicians-push the patients. Physicians are angry at the front desk and technicians; technicians are angry at each other and the physicians; and patients are angry with everyone and the government.

As I said, good idea gone awry. But the anger doesn’t go away. It lingers and grows.

Each person I talked with had someone to blame, was looking to blame someone or wanted to blame someone for the chaos in his or her office. I thought of our group-and we are no different.

As I sit at the patio table, listening to the night sounds and looking into the darkness of the ravine, I pick up my glass of Kool-Aid and wonder what flavor I’ll have to get used to drinking tomorrow.

Is anyone out there?

These 3 a.m. thoughts are usually insightful and decision provoking, but this night the questions are as multiple as the bunnies running through the back yard between the snowflakes. Oh, I am sure the bunnies are angry as well because the back light keeps coming on and giving away their location!

I do find comfort through knowing that a number of my fellow managers are probably in their back yards, wherever in the world, watching the stars and bunnies, and thinking: Is there anyone else out there?!

Dianna E. Graves, COMT, BS Ed, 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. She can be reached at dgraves@stpauleye.com.



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