From High Turnover to High Retention: The Staffing Strategy Your Practice Needs with Lynn Lawrence

Summary

Podcast Summary: Power Hour Optometry – Episode: From High Turnover to High Retention: The Staffing Strategy Your Practice Needs with Lynn Lawrence

Release Date: February 12, 2025

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Introduction

In this insightful episode of Power Hour Optometry, host Eugene Shotsman engages in a comprehensive discussion with staffing expert Lynn Lawrence. Filmed at the Heart of America conference in Kansas City, Missouri, the episode delves deep into the prevalent issue of high staff turnover in optometric practices and offers actionable strategies to enhance staff retention.

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1. The Challenge of High Turnover

Lynn Lawrence opens the conversation by highlighting the core issue many optometric practices face: high staff turnover. He attributes this to the lack of structured staff development programs, which often result in treating employees merely as temporary workers rather than long-term team members.

"Staff development is truly difficult because turnover is really high and there aren't, there's no real structure in programs in a lot of the offices." ([02:45])

Key Points:

• High turnover rates are detrimental to practice stability and growth.
• Many practices lack structured programs that foster long-term employee commitment.
• Employees often leave because they don't see a clear career progression.

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2. Implementing Structured Staff Development Plans

Lawrence emphasizes the importance of long-term staff development plans, typically spanning 18 months to two years. These plans provide employees with a clear career path, setting expectations and milestones that encourage them to stay and grow within the practice.

"Developing a staff development plan for your office is a long term matter of fact, my staff development plans on the short term are 18 months and then on the long side is two years. And that way it'll definitely reduce staff turnover." ([03:16])

Key Strategies:

• Clear Career Pathways: Define what "what's next" looks like for each role.
• Certification Opportunities: Incorporate certifications to add value to employee growth.
• Expectation Setting: Communicate the commitment expected from employees upfront.

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3. The Crucial 90-Day Trial Period

A pivotal part of Lawrence's strategy is the 90-day trial period. This period serves as a mutual evaluation phase where both the practice and the employee assess fit and performance.

"90 days is your non attributional point. It gives you a chance to figure out if you're a good fit for us." ([07:02])

Implementation Tips:

• Performance Metrics: Establish clear benchmarks to evaluate employee performance.
• Accountability: Teach employees to self-audit and take responsibility for their tasks.
• Extended Evaluation: Flexibility to extend the trial period if necessary, based on performance.

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4. Leadership Development Using John Maxwell’s Framework

Leadership within a practice is paramount for maintaining a healthy work environment and ensuring smooth operations. Lawrence introduces John Maxwell's Five Levels of Leadership as a foundational framework for developing leaders in the practice.

"Every office needs to start training leaders. The worst thing that we do is wait for somebody to retire or get sick or check out, and now all of a sudden, we have to throw someone else in the fire." ([22:54])

Five Levels of Leadership:

1. Position: Leaders have a title and authority but lack influence.
2. Permission: Leaders build relationships and trust with their team.
3. Production: Leaders focus on achieving goals and results.
4. People Development: Leaders mentor and develop other leaders.
5. Pinnacle: Leaders influence at the highest level, fostering a sustainable leadership culture.

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5. Effective Hiring Practices

Lawrence underscores the importance of hiring individuals with strong customer service skills and attention to detail. He suggests that roles such as front desk positions require emotionally resilient individuals who can handle high-pressure situations.

"They have to have Kevlar skin up at the front desk. And they can't be people that are so fragile emotionally because they'll go home and they're not going to last six months at the front desk." ([42:48])

Hiring Tips:

• Target Specific Industries: Look for candidates from customer service-oriented backgrounds, such as hospitality or retail.
• Task-Based Assessments: Incorporate practical tasks in the interview process to evaluate attention to detail and problem-solving skills.
• Assess Emotional Resilience: Ensure candidates can handle the emotional demands of the role.

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6. Conducting Effective Staff Meetings

Regular and structured staff meetings are essential for fostering communication and accountability. Lawrence provides a blueprint for conducting meetings that are both productive and engaging.

"I like to start a meeting off with something positive. I like to go through our patient comments and pick out one." ([53:38])

Meeting Best Practices:

• Positive Start: Begin with success stories or positive patient feedback to set an encouraging tone.
• Structured Reporting: Each department or area presents key performance indicators and discusses current performance.
• Time Management: Allocate specific time slots for each section to keep the meeting focused and efficient.
• Problem-Solving: Address immediate issues but avoid using meetings to solve long-standing problems without prior discussion.

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7. Metrics and Accountability

Implementing key performance indicators (KPIs) helps in tracking progress and identifying areas that need improvement. Lawrence advocates for transparency in sharing these metrics with the entire team.

"Metrics actually help us to see where we're performing well and where we need improvement." ([34:47])

Effective Use of Metrics:

• Area-Specific KPIs: Define metrics for each department to ensure clear accountability.
• Regular Review: Continuously monitor and discuss metrics during staff meetings.
• Performance Improvement: Use metrics to identify training needs and support employee development.

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8. Cultivating a Leadership Culture

A sustainable leadership culture is achieved by training every employee in some level of leadership. Lawrence believes that empowering employees with leadership skills fosters ownership and reduces turnover.

"Every person in the organization should be exposed to some level of leadership training." ([30:05])

Steps to Cultivate Leadership:

• Gradual Responsibility: Assign leadership roles based on performance and readiness, starting with small programs or projects.
• Mentorship: Provide ongoing support and mentorship to emerging leaders.
• Recognition and Rewards: Acknowledge and reward leadership efforts to motivate employees.

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Conclusion

Eugene Shotsman and Lynn Lawrence provide a comprehensive roadmap for optometric practices grappling with high turnover. By implementing structured staff development plans, fostering leadership at all levels, refining hiring practices, and maintaining effective communication through structured meetings and metrics, practices can significantly enhance staff retention and build a cohesive, motivated team.

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Notable Quotes

• "If you refuse leadership training, that is your exit key. You don't get to stay in." – Lynn Lawrence ([12:32])
• "Accuracy is critical in every area of the office." – Lynn Lawrence ([48:54])
• "Metrics actually help us to see where we're performing well and where we need improvement." – Lynn Lawrence ([34:47])

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Resources Mentioned

• John Maxwell’s Five Levels of Leadership: A foundational framework for developing leadership skills within the practice.

For more insights and strategies, tune into Power Hour Optometry and explore resources at www.PowerPractice.com.

Transcript

[A]

Welcome to the Power Hour. I'm your host, Eugene Shotsman. This is Optometry's biggest and longest running Show in its 13th season on the air. And today we're filming and recording from the Heart of America conference in Kansas City, Missouri. Now we'll have another show to talk about the actual conference and we'll publish that in a few weeks. But I was particularly impressed by one of the speakers here, a gentleman by the name of Lynn Lawren. And I think he can help many of us with one challenge that I hear about all the time and that is staffing. Lyn is a staff development expert and to keep his clinical skills up, he actually still works in a clinical leadership position. But more importantly, he travels the country and he teaches groups on topics like staff management, staff training and leadership development. And hearing him speak at the conference, I thought it would be super impactful to sit down with him and have an in depth discussion on some of the issues I hear about from practice owners. So to start in the episode, we get into turnover right away. Lynn gives us some secret formulas to keeping staff engaged, evaluated and accountable. And then we make sure that we talk about ways to make sure that those staff are engaged and don't leave. Then we talk about leadership development plans, common issues, leadership training, leadership mindsets and so forth. We hit hiring practices, what the first 90 days for an employee should look like, and so much more in this episode. If you are looking to resolve people related challenges, I hope you find lots of nuggets of wisdom in this episode. And before we jump in, I just want to offer a quick reminder to send me some feedback. Tell me what you think about today's episode or if you have any episode requests or content suggestions questions. Basically, any way I can be a resource, please reach out to me directly. If you go to Eugene Shotsman.com you can drop me a note. Again, that's Eugene Shotsman.com or you can go on the Power Hour website. Always enjoy being a resource for you and I hope you enjoy the show today. Hi, Lynn Lawrence, welcome to the Power Hour. Excited to have you on the show.

[B]

I am excited to be here. Thank you for the invitation.

[A]

Yeah. So you know, you and I are both speaking at a conference at the Heart of America and I'm, I really enjoyed some of your content as I was, as I was listening in earlier today and I realized that as you travel across the country, today's environment, you're addressing one of the top challenges that practices have, the staff development, staff burnout and staffing issues. Period. So if you were to kind of sum up the biggest issue that people are experiencing or really kind of break it down, what would you say when you're looking at today's environment?

[B]

Well, staff development is truly difficult because turnover is really high and there aren't, there's no real structure in programs in a lot of the offices. And so when we hire someone, a lot of times we just treat them like employees. We don't really treat them like long term, part of a professional staff. And so we, we teach them a job, but we don't answer a very important question, what's next?

[A]

I see.

[B]

And so staff development is something that I've taken as a personal project because we need to answer the question of what's next. I hired you as a tech, but what's next? And so I wanted to take everybody that we bring on as a beginner to the next level. And so developing a staff development plan for your office is a long term matter of fact, my staff development plans on the short term are 18 months and then on the long side is two years. And that way it'll definitely reduce staff turnover. And so giving them a projected pathway, it gives them expectations. And for me, I'm a big advocate for certification. So a part of that staff development plan is to end up with a certification.

[A]

Yeah. And so this is kind of interesting as you're thinking about it, the reality is that, you know, you're going to get a lot of people say, well, I don't really, I can't really answer what's next for a staff member because chances are they're not going to be here in six months because half the people I hire are gone within six months. And you know, I guess you would probably say, well, what's the chicken or the egg type of scenario.

[B]

Absolutely. So if, when I hire, I hire for 18 month program or a two year program, there's already an expectation that I'm going to have them there for a long term. Whereas if I just hire an employee, chances are I may not keep them for six months. And so there's no expectation of longevity if I just hire an employee.

[A]

Yeah. And what I've heard from practices is that techs are some of the hardest positions to hire for today. Is that what you're seeing too?

[B]

Oh, absolutely. And not only that, if you look at it, the texts are being taken to the next level. In many cases they're not only texts, they're becoming scribes. And it takes a while to get to that level. And so when you have someone that you've trained and usually if you have a scribe, you've had them at least 12 months. So there's no one for one swap. When you can't find another tech or another scribe, you just get another breathing body.

[A]

Right.

[B]

And so we start that process over.

[A]

Right. And so when you think about this tech 18 month program, you're saying, I hire a person and you know, sometimes I talk to practices and they say, well, we just hired someone, they worked at, you know, Burger King two weeks ago and now they work here. And you're saying at the point of hiring there should be an expectation. So how do you, how do you articulate that expectation to the former Burger King employee?

[B]

Well, the approach is if you take this job, you're going to enter a 18 month program. In that 18 months, we have landmarks that you need to accomplish throughout this program. So for your first six weeks, we expect you at the end of those six weeks to take a test on some of the basic skills that you've already learned so we can find out where your strong areas are and where your weak areas are. And if you go into this process, if you accept this job, we expect you to be here for 18 months. And so during that 18 months, we're going to invest in you as a part of our team. And we want you to be at this level to be able to work fairly independent because we've invested so much in you and we don't want you to take the job if this is just a job for you. But we want to teach you and train you as a professional in the medical field. Whether you worked at Burger King or not doesn't really matter. The goal is to make you a medical professional.

[A]

Yeah. So interestingly at that point you're talking about, okay, well we're expecting to take you in at level zero and we're expecting to get you to level five by, by 18 months. And there's milestones in the, in the middle. What about the employee who says, well, when I get to level five, you're going to pay me a lot more. Right.

[B]

So actually in the 18 month process, there are opportunities to get pay raises. So normally if you know nothing about the field, we're not going to start you out mid upper level pay. We're usually going to start you out as a certain pay level. 90 days is a really telltale sign. Are they the material that we were looking for for the position? And so we usually say 90 days is your non attributional point. It gives you a chance to figure out if you're a good fit for us. And it gives us an opportunity to figure out if you are a good fit for us, the team. And so if you're not a good fit for the team, you're not going to make it to 91 days. And so there are some things that I like to teach. Like if you are late two times in that 90 day period, the third time we consider keeping you or not because that means you're on average you're going to be late for work at least once a month. And then we work in the medical field, I think that a patient appointment is like an invitation to a party. And we don't have staff to actually start their party. They don't think they're having a whole lot of fun at that party. And so we need to teach our staff accountability through the process. So that 18 months is not just about teaching them skills, it's teaching them about how to fit on a team and their team responsibilities. And everybody gets responsibilities. After the six month period, we teach them how to report on their own performance. It's not just we're going to give them a performance report, but let's just say if you're a tech and we want you to, we want you to self audit pretty much your own record. So I forgot to put the VAs in this many times. I forgot to put the Iops in this many times. If they can catch their own mistakes, the doctors don't. They will find that the doctors are a lot happier with them if they can catch their own mistakes. So it's not just teaching them a skill, it's teaching them how to be accountable to that skill.

[A]

The self accountability is really interesting to me. So how do you set that up? I mean, is it, is it just being super clear about the expectations or being super clear about them recognizing their own mistakes, how do you do it?

[B]

So it depends on the work dynamics and the resources within the office. So if there's, let's say if there's a scribe in the office with the doctor, we just give them an audit sheet. So when you open up this chart, did you see these things were in the chart? If there's something missing, they only have to put a hash mark on that sheet.

[A]

So they look at one chart out of the 25 that they touched in the previous day or something.

[B]

Absolutely. And we look for trends within that time period. So let's say if it's someone that's been there for four weeks, we expect a few more mistakes, but we shouldn't be leaving them. This is not an independent worker yet. And so whoever is identified as the individual's trainer is really a critical part of that. And that's something that's missing in a lot of offices. Normally we do what we call just in time training. It's like, dude, I'm going to show you what I need you to do right now. And that's the end of it until I can find time to show you something later. Whereas in the staff development program, they can actually read at home, watch videos at home, they can prepare for what's coming because they know what's coming and it's a lot better than just in time training.

[A]

So you would say that if I have someone starting my practice and they're, you know, two weeks out of Burger King and that that person's job is going to be an 18 month program, as you said. So say, well, let's assign a trainer and then we're going to set up an audit process within. How quickly am I going to self audit my work?

[B]

You're not going to start auditing probably for eight weeks. And so there's so much to learn. The learning curve is steep in the medical field. There's things like compliance that they have to learn. You can't wait six months to teach compliance. They would derail a lot of programs in the process, waiting six months to teach them that. That's one of the reasons why a trainer is so important as well, because they can help. Remember, if you come from Burger King to the medical field, it's a whole new world. And so to teach a tech how to basically crawl, then teach them how to walk, then teach them how to run, then teach them how to teach others to do the same, that's a process. And so it's so important to be able to teach them what that map looks like. And so when they can see what the map looks like, they said, I'm preparing to crawl, I'm preparing to walk, I'm preparing to run. And if they're really dedicated, they're going to prepare before they get there.

[A]

Yeah, that's good. Now, a lot of your methodology is based on, I think, your background in the military.

[B]

Right.

[A]

So talk a little bit about that because, I mean, that's one of the best training programs in the world and it needs to be because, you know, lots of people's literal lives are at stake.

[B]

Absolutely. So I truly enjoy the fact that I spent 30 years in the United States Air Force and 20 of those 30 years I was actually A medic. But when I was trained as a medic, you don't get to touch a patient until you pass the classroom didactics. And so to get to a point, I mean, it's like almost a reward. It's like, I'm going to get through the classroom part, I'm going to get to the classroom part, and I get to actually deal with a real patient. And so when I transitioned from the military into the civilian sector and I found out that there was no real structure in the training, I was like, it was a gas. It's like, how can you be a good tech if you don't have good training?

[A]

Right, right.

[B]

And so my goal was to actually start developing training just like I had in the military to work in the civilian sector. It was a little bit of a challenge because there's a big difference between if you just have four employees or if you have 25 employees. Those two cultures are totally different because if you only have four employees, one calls out, 25% of your staff's not there today. And so you have to develop programs that are tailored and that will fit in the. In the actual. The size of the organization that you're working with.

[A]

Yeah. So what have you found to be some of the most effective ways to, you know, as you're thinking about a practice that has very. We'll call it, you know, they have standard operating procedures, but like you said, you know, they're doing your version of just in time training, and they're trying to get a warm body to fill a spot. I feel like a lot of practices are. It's stuck in that, you know, it's kind of the perpetual hamster wheel of, I got a new person, I gotta train that person. That person's not gonna show up to work in two weeks. I gotta get another new person to backfill them if they, if they don't show up. So I feel like there's a. There's a lot of issues around staffing that have to do with both reliability, but then also, like, I don't have time to assign a trainer to every single one of these newbies, and I don't have the, the resources to be able to kind of, you know, to take them through a robust program. I need them to be productive now.

[B]

So that's, that's very important and impressive because every office is different. And you, you said something that was really critical. They're stuck in a certain ritual or routine and they don't know how to get out of it. So I can Tell you when you develop your processes correctly and you put checklists in those processes, what you reduce the friction in the training process because the staff has a checklist to go by. And so you already have a manual. So to say, to begin with, I go into offices and there's nothing. There's no manual, there's no checklist. And so a lot of times we do just, just in time training where we go here, I'm going to show you how to do this and I want you to do it. Well, they don't know why they're doing it. They don't know anything other than what you just spent a few minutes showing them. And they're going to do the best they can. But if the why never comes, you have robots, you don't have text.

[A]

Yeah. And if they don't understand the bigger picture, then they're not able to contribute to the bigger picture.

[B]

Absolutely.

[A]

Right. Now, you talked a little bit about leadership development with me yesterday and I know you have a pretty strong opinion on this. What's your take on how leaders should be developed inside of a medical practice?

[B]

So, you know, in the medical field, it's actually a very interesting dynamic. So I work with surgeons and clinical doctors and it's really interesting, the hierarchy in the medical field. And so the surgeon is next to God and so we have to make sure that they are taken care of. But when they're put in charge, it doesn't mean that they're a great leader, it means they're a great surgeon. And so leadership is something that you have to train in the military. If you refuse leadership training, that is your exit key. You don't get to stay in. And it doesn't matter if you're enlisted or a commissioned officer, once you refuse leadership training, you have told the military, your future in the military is pretty much over. And so when I transition, I look for leadership training in our industry, it wasn't there. And so it's like, well, I mean, how do you become a great office manager? How do you become a great lead tech? How do you run a contact lens program if you haven't been trained on how to lead? And so we find that there's not. When you have really good leadership, your consistency level goes up, you reduce your problems and the friction in the office because you know how to handle certain situations. But without training, it's like feeling around in the dark. And eventually it's going to hurt because you're going to touch something you are do something you have no business doing. And so I've met some amazing leaders, amazing people in the field. I've met doctors that have unlocked the key to leadership. I've met office managers that have done the same. But the ones that are dealing with a lot of drama and chaos, they really struggle a lot. And that and a lot of it comes down to leadership training.

[A]

So what are the components of leadership training that you think people should really be aware of?

[B]

Oh, very good. So I'm a big John Maxwell fan and so he has a book called the Five Levels of Leadership and it identifies all the different levels of leadership. And the first level, people are familiar with the first level. I have a title and I have power to make your job go away. So you need to listen to me. That might work for a brand new employee. It might work. Fear and threatening works. It's a temporary, it's just a temporary fix. But if you want long term employees, you have to have a plan for long term employees. And that's where the leadership comes in. The leadership is responsible for the culture. So I'm a consultant. And so when you walk into an office, they don't call consultants in unless there's a problem that needs to be fixed.

[A]

Right.

[B]

And so when I walk into a problem, the first thing I do is assess the leadership. Tell me where you're going, tell me your plan to get there, tell me what programs you have in place to actually make this happen. And that's where I begin. Because it doesn't matter. You don't want to work from the bottom up, you want to work from the top down. And it makes all the difference in the world because whoever's in charge is steering the ship.

[A]

Yeah. So you were talking about the five levels just so that the audience gets a sense talk through the rest of them so that they can kind of get a picture of if you, I imagine if you're listening, you might be thinking, well, what level of leadership am I? Whether I'm the office manager or the owner of the practice? And what are the things that distinguish those different levels?

[B]

Well, that's very good. So the first level is pretty much, I have a title and I don't really know what to do with it, but I'm in charge. And so I'm a bark orders at people. I'm gonna, I'm more focused on tasks than I am people. But the level two is where you actually start learning that relationships are very important. And so you start treating your staff totally different because you want them to be a part of the team. You want them to Feel like they fit in. You want them to learn, and so you. Relationships become more important. You still need to get work done, and that's level three. It's where you can focus on making sure that the work is actually getting done. So level one, you just pretty much have a position and you have people under you. Level two, you making those people feel at home, and you're getting them to want to do the job and want to belong. Level three, the job is very important. You already have the people following you. I have this rule. If you. If you look at your team and you said, and you turn around and you don't face them, and you say, everybody that wants to follow me, line up behind me. If you turn around and there's nobody standing up, you've been fooling yourself. You're not a leader. Because people truly want to be led. People want to know what direction we're going in. So level one is just you being there. You got a job, you got a title. Level two, you know that the people are important. Level three, we want to accomplish the mission that level three is really, really where the rubber meets the road. If we have goals, this individual understands the value of the goals and the people, and he's teaching or she's teaching the people the value of the goals. Level four is when we get into mentoring and we start making sure that we're making leaders and not employees. It's great to have followers, but followers will always be followers until you teach them to be leaders, to be leaders. And every office needs to start training leaders. The worst thing that we do is wait for somebody to retire or get sick or check out, and now all of a sudden, we have to throw someone else in the fire. It shouldn't be that way. If we have an office manager, when that office manager is out, we should already have someone TR to fill in. I mean, anyone can be. Get sick. I mean, you know, Covid takes people down for weeks at a time, but the business of optometry still goes on. And so if you only have one deep position in the office, you have a very volatile office.

[A]

Yeah. And I think what happens sometimes is that exactly what you just described. And a person quits or checks out or gets sick or something like that, and then we need someone. So we just take our best person, person who is good at the technical job and say, well, they're good at the technical job so they can be a manager. So now our best optician is the manager of the optical or the, you know, or the new office manager. Depending on the size of the practice and at that point we might be in a place where, you know, they have no leadership skills but they have good technical skills. So what do you do with that type of person?

[B]

So you have to train the them and this is one of the big issues. You can, I can be the best tech in the world and I could love my job and then you elevate me to a leadership position and now I don't love it anymore because I, I have not, I'm not prepared for that. I, I feel so much stress because no one's taught me. They gave me a position with no training and now all of a sudden I come to work every day, I don't know what to expect, I don't know what to do and it starts to stress me out. And honestly, you can take a really good tech and ruin them by doing such a thing. And so, but when you train them and you teach them the role and that's why it's so important to do it when you have the resources, if you have a good office manager, you tell them, train someone that can do your job when you're not here. It shouldn't be a threat. Delegation is a key part of actually being a really good leader. And at level four and John Maxwell, if you don't know how to delegate, you're not going to get a good score on level four because that's the goal is to teach someone to do that job up at that level. Level 5 is actually where you are no longer working the floor, you're just reaching down, picking up leaders, picking up leaders, pulling them up, pulling them up. And so level five leaders are, they use their influence to actually make sure that the level four leader has been elevated up to level five. And so there's a lot that happens at the level five leader, but they're not necessarily on the floor. They're actually making sure that level four leaders are being trained well and they're being prepared for level five.

[A]

Got it. So base, if somebody had to start the process of implementing a leadership training process with some of their staff, right. Or at least assessing whether my staff has leaders leadership ready in some capacity, where would they start?

[B]

So you need to start teaching them the characteristics of leadership. What, what does a leader look like? What does a leader do? I have had a couple of practices where they, they really, really smart, fast learning, very, very young office managers and they could do the job but the area that they lacked in most is emotional intelligence. They would blow up. So in the military we had this term. You lead by example. So if I'm going to be walking around the office yelling and screaming and throwing a fit, my children would walk around the office and do the same thing, the ones that I've been mentoring and grooming, because that's the type of culture that I've allowed or I've endorsed. But if you want a professional staff, you should be professional at all times. I tell office managers, I said, you know, you're a human. You may feel like you want to go, you want to scream, but you never do that in front of your employees. If you need to scream, you go out to your car and you turn on the engine, you turn up the music and you let loose. But do not do it on the floor, do not do it in front of your folks. Because now you're creating a culture that you're going to have a hard time dealing with down the road. You lead by example. If you want certain behaviors, you need to perform the behavior and watch your staff emulate that behavior. And I struggle with doctors that, well, I own the place, I can do what I want. Yeah, you can. But is it good for your practice to do what you want?

[A]

And you make a really good point, you'll get back exactly what you put in. So if you make a behavior good or if you make a behavior acceptable at the top, then that's the behavior you're going to see at all levels of the organization?

[B]

Absolutely. Then the more consistent you are. My wife and I, we've, we worked in the children's ministry at church for over 30 years and parents ask us all the time, why is it that my children listen to you, but they don't listen to me? I said, well, I'm consistent. If I say no, they know. I mean, no, I don't. We don't sit around and negotiate. I have a joke that I don't negotiate with terrorists when I'm dealing with the children. But the, the, the practice is the same way. We are big children. The more consistent we are, the more the people understand the boundaries of what happens within a, within a culture. And the more consistent the leadership is, the more consistent those that follow them will be.

[A]

So you were talking about a tech starting a couple weeks out from, you know, a different job. And that tech is, and that tech is going through their 18 month program. @ what point do you start introducing, in that 18 month program, do you start introducing the characteristics of leadership?

[B]

So, okay, so if they have absolutely no training in the field, I'm not going to start any Leadership training probably for six to eight months. And, and I give a window like that because some people are fast learners and some people are not. And so in our practice we had like, for example, we had some new, we hired five new millennials at the same time. Not recommended, but, but two of them were absolutely exceptional. They learned the tech skills so fast that we actually allow them to become scribes. Normally a scribe takes us about 12 months, but they were scribing by the seven month period because one had a background in medical coding and the other one had a background in computers. And they teamed, they partnered and man that partnership blossom into knowledge and wisdom. And we never hold back people that want to learn. We always want to set them on the right path. So we give them checklists to follow. We, we make sure we monitor what they're doing so that we don't get a train wreck at the end of this. And then we allow them to move at a pace that's commensurate to their ability to understand and learn. And so at leadership, if we wanted to give them a leadership position at 10 months, they would be ready. But we just have to make sure they're ready. Everybody's not ready for leadership at 10 months.

[A]

Do you think that every person in the organization should, because you mentioned the military, you know, your pathway out is saying no to leadership training. Do you think that every person in the practice should be exposed to some level of leadership training?

[B]

Absolutely. Absolutely. So I get a great tech. And so we're going to get them to a point where they're doing their routine daily duties in a way that we have found to be totally acceptable. And then we're going to move them into another area, let's say maybe we're going to give them a responsibility for our contact lenses. And that's a program that is not an extra duty, that's a program. So we might move them to be head of our contact lens program. And we're going to give them the parameters and the checklist to follow. We're going to ask them to report on that program. If that program is your responsibility and the team is counting on you, you will report on that contact lens program and we'll teach them how to do that. And so that's their first introduction to maybe being an independent leader, is giving them a small program and see how they actually function with a small program. And then we'll give them a little bit more responsibility. And once we do that, let's say we working on a certification called an ocular HYGIENIST So dry eye disease is really a big program within the practice. And so let's say they have done well with the contact lenses and they have a desire to want to become an ocular hygienist. So we want to teach them all the areas of the dry eye program. And when they're ready, they may get an opportunity to run that dry eye program. But that's going to take another. That may actually be another six to 12 months. And so, but we want to give them an opportunity. If they see an area that they really like and they want to thrive in, we want to encourage them.

[A]

So you're saying every employee in the practice should have an opportunity to do something and should get some sort of leadership training, even if it's an understanding of how a leader behaves?

[B]

Absolutely.

[A]

Now, now the skeptic in me or the skeptical practice owner listening is going to be saying, okay, Lyn, that sounds great. Except every time I say, oh, hey, it's time for a leadership opportunity, or I'd like to get you some leadership training, or I'd like for you to start thinking about future leadership opportunities, then immediately that employee is coming back to me and saying, well, when am I getting my raise?

[B]

So, so we explain raises this way. If we give you a new position, we want to see you perform in that position before we have a discussion over a raise. So let's say I give you the contact lens program. If I give you the contact lens program and I give you a raise and you don't do well, I want my money back. I gave you the raise for the contact lens program. Or would you prefer that we give you 90 day trial of the contact lens lens program leadership and after you do well in that area now, I'll give you the raise and then you.

[A]

Define what well means.

[B]

Oh, absolutely.

[A]

Do you give everybody metrics? Do you give everybody what are the kinds of things that you measure to figure out whether somebody's progressing towards a leadership role?

[B]

Depends on the program. But yet every, every program has to report to the team. So we decide what the metrics will be for every area. So the contact lens program will have metrics. Let's say how many of our patients are ordering one year supply? Let's say if I have three doctors, are they all doing the same? Or maybe one of my doctors are lagging way behind the other two. And so we'll talk to the doctor and say, hey, doc, talk to me. Tell me how you're actually explaining that when your contact lens program purchased to your Patients. We don't want to beat the doctors down. We don't want to beat the staff down. We want to build them up. And so metrics actually help us to see where we're performing well and where we need improvement. And so we don't use it as a tool to. As a correction tool for performance. We look at. We use it as a correction tool for potential. And so this is what our team can do. We've done this in the past. All of a sudden, we're actually taking a dip. Since that's your. You're my subject matter expert now, Eric, can you explain to me what's going on?

[A]

So what's interesting is you're saying, give somebody the leadership talk at some point relatively early in their employment, but basically everybody should have an opportunity at some sort of leadership based off of how they react to that. You then help get them some additional responsibility, but don't pay them for that responsibility until they succeed. And they succeed based off of criteria that you set at the time that you're giving them that responsibility.

[B]

Absolutely. So the pathway for staff development should be clear for everyone. And everyone wants to be paid more money. I mean, as a consultant, I walk into the office, I get a whole team there, docs everybody. And I ask this as my first question. Who would like a pay raise? And I love to watch all the docs raise their hand. It's like, I own this place. I would like a pay raise, Lyn. And so we have to talk about that. I'd like to talk about that early and start like, you know, we don't have a little guy in the back and he's green and he's putting in white paper and he's turning this little handle and cranking out dollar bills. It doesn't work that way. So my second question is, where does a pay raise come from? I want the whole team to hear this. I want the whole team to understand that there's no magical foreign. Just because you woke up this morning, you thought, hey, it's a great idea, I think I need a pay raise. You know, everything's more expensive. That's true. Everything's more expensive for the practice as well. So when you teach the staff the business of the practice, they understand that there is no magical pay raise. If we're not making more money, where do we get the money to pay you more? And that's why it's so important to teach every area, their responsibility and their responsibility to the area and to the team. It's all interconnected and I love bonus programs. I prefer bonus programs over pay raises. We're. We're thriving in our revenue. We can share the wealth. But when we're not thriving, our overhead is not way up here because we gave everybody this mega pay raise, and now we. We're not making the money that we were making six months ago, and now we're struggling with making ends meet. So I'm more of a. An advocate to teach them about profitability. And when we are really profitable, we share the wealth. When we're not being profitable, we just need to work.

[A]

So do you suggest that practice owners kind of open up the books to employees in some way or at least share the key metrics of profitability with employees?

[B]

I like key metrics. Some employees are not ready for the whole picture, the big picture yet. But how well is your area performing? And it's really interesting. It's like we're underperforming, but I want to pay raises. Like. Like. Does that make sense to you? That's what I asked him for. Does that make sense to you? I mean, if this was your practice. I love this question. If it was your practice and you had an employee that was working in an area that was underperforming, would you give them a pay raise? They go, no, what are you doing here?

[A]

Right?

[B]

It's like, dude, we need to pick up your area, and we would love to give you a pay raise. We would love to share the profits of the practice. But if you don't understand the profits of the practice, you come with questions that we disappoint you with our response because you don't understand the big picture.

[A]

All right, I thought the 90 days that you mentioned is so critical. So when we come back from the break, I'd like to zoom in to how you recruit and then how you tell within the first 90 days whether an employee is going to fit or not. We'll be right back.

[C]

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[A]

Hi, we're back in the Power Hour with Lynn Lawrence. So we're talking about one of the biggest problems that practice has cited in 2023 and 2024 and certainly going early in 2025 is staff management, staff issues, staff burnout, staff problems, problems with the team. And Lynn's doing a great job of kind of diagnosing piece by piece where we've got to look or which rocks, we've got to flip over and see what's underneath. One of the things that I wanted to talk about was hire, right? And you Talked about this 90 day, this 90 day trial period that you share with every employee in the first, you know, as you're bringing them on board. So tell me more about that and how that process works. And again, you know, sometimes practices just try to bring in a warm body and teach, but sometimes practices also bring in somebody with experience, medical experience. Maybe they weren't optometry experience. Maybe they were whatever they, maybe they worked in a physician's office or a primary career office and, you know, that or something else. So they may be familiar with, I don't know, hipaa, but they may not be familiar with how a slit lamp works or what. Or what some of our testing looks like, things like that. So let's jump in first into what you look for in an employee when you're trying to make sure that the practice hires right.

[B]

So let's go to the ad. Okay, I need a new employee. So I heard Dr. Selena McGee yesterday said something that was absolutely amazing. She said, I intentionally make my ads for my new employees difficult.

[A]

Okay.

[B]

And then she says I have to do a psych eval or personality testing. And her personality test lasts an hour. She said it weeds out a lot of people that are not serious about the job. If I'm going to invest an hour of my time for this position, I really want that position. And so I found that to be very creative on her behalf. But a lot of times we run an ad and we just put enough information in there to grab any type of Employee. And one of the points that you made was what background do they have? Well, it's a lot easier to transition someone who's worked in the medical field already than someone who's never worked in a medical field. And so if they've worked in the medical field already, you're not starting at zero. If they worked at Burger King and they've never worked in the medical field, we started zero. Now they may have good customer service skills. Now that's one of the hardest things to teach, is how to be nice to people. If you don't know how to be nice to people, medical field's not for you.

[A]

Yep.

[B]

Because many people walk in the front door, but I have this rule. I own them. They're in my, this is my world, my little magic wand that I have that rings in my head when a patient walks in the front door. I want them to have the most magical experience while they're here. I want to be able to define why they come to our practice and not go to our competitors. And that's something that's very difficult to teach. So if you have someone with really good customer service skills, you have a good start.

[A]

Yeah. So you're saying maybe higher for the customer service skills because those are really difficult things to teach. You can't really take someone who hates people and make them like people. Or even if you could train them to like people, naturally they're going to be expending so much more energy to do that. So, you know, people who self select and areas of hospitality or even, you know, service based positions tend to do well. And I'll share a quick story is that we have somebody on our team in our organization who was a burnt out. Who was a burnt out barista at Starbucks. And you know, it was a very busy Starbucks. There was, it was in the medical area. So she dealt with a lot of doctors as a result of this. And she, when she transitioned to our team, she already had the skills, the people skills. She also already had the multitasking skills, the lots of moving pieces and parts. And I got to remember this, and I got to do that. And this is in this order. Whatever. So we tried several positions to make a fit and she's turned out to be a phenomenal project manager. And a project manager needs to have a lot of people skills to interact with the people that they're facilitating work from day to day. But they also need to make sure things get done and they get done efficiently and nobody's waiting for stuff for too long and things and so that person turned out to have phenomenal skills that kind of predisposed them. And yet we just gave them the job training and the industry training for that project management position. I don't think she would have known when she was working at Starbucks that she was developing the necessary skills for a project manager. So you make a really good point that people with really strong customer service might be good pickups for an eye care practice. So what fields or what other fields, fields do you think might be really good in terms of predisposing someone for something that we need in our practices?

[B]

So I've heard several doctors say this. I hired my waitress at a local restaurant, right. Because the way they took care of me when I was at the restaurant. So someone that's already in the customer service industry that you've experienced or someone else has experienced, that have, those are good potential hires. But if they don't do pressure well. So let's talk about the different areas in the office. The front desk, normally not the best paid in the office, but boy, I tell you, they take bullets. They need, they have to have Kevlar skin up at the front desk. And they can't be people that are so fragile emotionally because they'll go home and they're not going to last six months at the front desk. So you need people that are emotionally tough at the front desk and can stay focused and can diffuse a situation, not pour gasoline. And so, but a tech may not necessarily need those same skills at the front desk because they're dealing more with one on one at the front desk. Your phone's ringing, you got check in, you got checkout, you have, there's so many. Multitasking is a superior skill set to have for your front desk worker. Whereas tech may actually be able to focus more one on one. Optician is more of a one on one. But the front desk, they're, they're, they're pulling and they're shucking and jiving up at the front desk. And there's a lot going on. So not everybody can handle that. And so a good training program. And you were Talking about the 90 day, you have to monitor closely the first 90 days. And they may be strong, super strong in one area, but if they, let's say, have focusing issues, it doesn't matter where you work in our office, if you can't stay focused, you're not going to do well. If you can't complete a task, you're not going to do well. And so you have great customer service skills, great People skills. But if the other skills aren't being developed, developed. 90 days is going to be a long 90 days. And I'm okay with extending the 90 days. Let's say we have someone that's maybe not a fast learner. Let's give them an additional 30 days. I may extend the 90 days to 120 if I feel that they're actually going in the right direction. Just a little bit slower than I would like for them to. But that 90 days, that is critical. There's landmarks that they have to meet at the 90 day.

[A]

So what are some examples of landmarks for the, for, for attack, for example.

[B]

Attack. Let's say, let's say within the first two. If they can't take visual acuity, they're not going to make it four weeks because that's really easy. You teach them how to do visual acuities, you teach them the importance of visual acuity. And when I say two weeks, that's two weeks past compliance training. It's like we throw so much at people. The learning curve is so steep in our profession. I mean it doesn't matter what position you put them in. So the front desk, you have to really have people that can remain focused. And so Suzanne with out an E. And we can do everything in that visit correctly. We can do all the diagnostic testing, everything up. But if she was put in the computer role, we don't get paid for seeing Suzanne.

[A]

And Suzanne's experience, when she sees her name misspelled on the paperwork, she might not even say anything. But you know, she's pissed off. You know, she might not even come come back.

[B]

They don't even care enough about me to spell my name right. That's the question. So people working the front desk have to be accurate to the point and understand why accuracy is so important. And we actually monitor that in metrics too. And a lot of people don't realize it comes from the billing department. Reasons for rejection. If all of our reasons for rejection is that we can't input the patient information correctly.

[A]

Yeah, right.

[B]

That's a problem. And that problem is at the front door, us.

[A]

And so details, front desk details.

[B]

Actually every, every area in our office requires details.

[A]

But so attention. So this is a good point because, you know, my business, for example, curiosity is the skill that every position is required. That every position requires. So, and you know, whether it's marketing or practice consulting or practice growth training, you know, any, anything we're doing with technology, curiosity is the core skill that if you don't have that, we're not going to be able to. It's just not going to work out. Attention to detail in a practice sounds like it's the core skill from your perspective.

[B]

Absolutely. From check in to check out. Attention to detail. So at the front desk, if you can't get the imprint, if you can't get the patient put in the computer correctly, you're not getting paid for anything behind that. As a technician, your doctor is so dependent upon you, you for handing them information that is accurate and correct. And so if you don't know how to perform a test and you're just winging it, you could be setting your doctor up for failure. You can actually. The doctor misses a diagnosis because you didn't put the information in the computer correctly. Or patients. Every patient is different and some patients would prefer talking to a doctor. Doctor versus a technician. So the technicians have to be really good at winning them over so that, because chair time is important. So if the, if the, the longer the patient is in the doctor's chair, the less money the doctor is going to be able to make. And so hiring good staff, a good tech is going to be able to get through the screening process in a, in a, in a, in a manner that is actually healthy for the whole process. Process and attention to detail. Doing it right the first time. Accuracy is, is critical in every area of the office. Opticians we have a remake metric and that eats into the profit because we only get paid to actually do that once. So we have to do it twice or three times because we're sloppy in our work, it starts to eat the profits.

[A]

Yeah. And I would add a revenue per patient metric. Absolutely. For the optician because quite frankly, if they don't have good sales skills, and I say that with a massive leaning towards a positive leaning towards the word sales, not a sleazy leaning towards the word sales. If they don't have good sales skills, we're missing opportunity there as well. But I think to your point, attention to detail, that's the core thing. So how do you interview for attention to detail? Or how do you know up front whether attention to detail is something that they have?

[B]

So, so we always start out with tasks that are fitting. So the interview process is everybody brings their best, they dress the best, they act the best during the, during the interview. But you don't really know a staff member until you've been put up under a load at test. And so, excuse me, giving a, a task that is difficult or given a patient that is difficult, you, you monitor how they handle it. And so I heard a guy one time speak, he said they're like people like tea bags. You don't really know what flavor they are until you dip them in hot water. And so when the pressure is on is when you want to watch your, your teammates. You don't want anybody to go 90 days without any pressure. Pressure. That is a big mistake because how do they respond to pressure? Now let's say an optician that had 90 days never responded. Pressure. Now they have somebody come in yelling at them, they throw their glasses on the table and they pick them up and they throw them back. Well, that, that should have been discovered in the first 90 days. And so we really have to teach professionalism. And those are, I mean, so when I joined the military in 1979, my parents taught me what respect was. Today in the military and basic training, they have a course on respect. And so our culture has shifted a bit. So what that has taught me is this. If you want a certain behavior in the office, you need to talk about it. And staff meetings are, if they're facilitated, take. If they're facilitated correctly. Are one of the best learning times in the office. When you have to shut down for a staff meeting, it's costing your practice a lot of money. So a staff meeting is so critical and it's so important. Everyone on the team needs to know how important the staff meeting is.

[A]

So, okay, tell me some of the things that make that meeting effective versus ineffective.

[B]

Okay, so it's team communication, number one. It's a display for leadership in every area. Area. Because I'm not, I don't believe that the, the owner should have to stand up in front of everybody and give a state of the union address. If you work the front desk, nobody knows more about what's going on at the front desk than you. You are reporting on the front desk.

[A]

I see. So that's the point of self accountability that you were talking about before.

[B]

Yeah, absolutely. Same thing with the text. Let's say if our primary practice is glaucoma and we monitor the number of octs and visual field tests that we're doing, let's say last year we did 70 octs and 68 visual fields, but this year we only did 30 octs and 25 visual field. Someone that's working in the tech world should be able to answer that question on the spot. Well, we had two doctors out. One was sick and the other was scheduled vacation education. That explains why our numbers are done. But I don't know why my numbers are down. I Mean that your workload has been cut in half. Do we have too many tags? Is the next question. And it's like, what happened here? And so maybe the machine broke, maybe we weren't able to perform the test. But at that meeting, someone is explaining to the team why our numbers are that. And you're the one that's doing it all the time. You're the one that's doing it every day. There's no one better in the practice to actually explain.

[A]

That's great. So what else happens in a good meeting versus a bad meeting?

[B]

So a good meeting, the leadership stands up. I love to start a meeting off with something positive. I like to go through our patient comments and pick out one. It's like I have a neuro lens patient that put on their glasses for the first time. They sat there and they begin to weep because their eyes felt so good putting it on. Or a dry eye patient that has been struggling. We had a dry patient. She was for six years, her eyelids would stick to her eyeball in the morning when she woke up. We performed treatments on her. And then she called the office back three days after her treatment and she was crying because she said, this is the first morning in six years that I woke up my eyes, my eyelids weren't stuck to my eyeballs. Those are the type of things you want to start your meeting off with a brag. And so it sets the tone that, guys, we're not here to beat you down, we're here to build you up. And then we go into all of the key performance indicators and we go into them by area. And I like to rotate the area so nobody feels like I'm always having to go first. So we rotate it around, but every area has to report on their key performance performance indicators.

[A]

Good. And then after that, after that, let's say this.

[B]

We. Everybody doesn't have any unlimited time. Everybody's on the time. So let's say if we have a one hour meeting and we go by section, we give everybody an allotted amount of time. So whatever you're going to present to the team, you have to do it in this amount of time. And let's say this, if there's an area that's broke, the meeting isn't the place to actually fix a problem problem. If it's a safety issue or a patient care issue that needs to be addressed, we'll go ahead and address it at the meeting. But if we knew the problem existed two weeks ago, why did we wait for the staff meeting to actually have the Discussion. Now, if it's something that's really important, we can say we discovered it two weeks ago and this is what we've done to fix the problem. But we don't wait to the staff meeting to begin to fix the problem. That's where you teach ownership in every area. It's like, it's okay to tell us. Let's say we, our contact lens program, our supplier, can't get the lenses in. We need to find another supplier. And this is what we're doing to find another supplier that's important to this, the entire team, because the front desk needs to know when they get all those calls in. Why is everybody calling about their contacts? Well, we. We have a supply issue issue right now. That's an easy thing for them to answer at the front desk. They don't have to go find the contact lens tech to answer that. Everybody on the team just learned the same information. So when we're having a staff meeting, we're talking about things that impact the entire team. And each section will actually present what's going on in their area. And it's real time because those are our subject matter experts and it makes.

[A]

Perfect sense because those are the people that you've elevated through some leadership opportunities, and those are the people who now feel more ownership in the practice. This, which goes back to our first point, which is how do we get people to stick around and retain and we invest all this knowledge and all this, all these resources in them and then they leave? Well, they won't leave if they feel like they have ownership and if they feel like they're working towards something. Back to your very, very first point was understand where they're going and give them the next steps. The next. The roadmap of where they're headed.

[B]

He said that very well.

[A]

Well, so thank you so much for being here, Lynn. I think this is just kind of the start of this, of a massive, deep dive into your wealth of. So thanks for being a resource for our listeners. I think this has been absolutely wonderful and hopefully we have some future conversations on this really important topic that's troubling so many practices today.

[B]

Absolutely. And I thank you for the opportunity to be here with you as well. And I'm available whenever you need me.

[A]

All right, thanks.

[B]

Okay, thank you.

[A]

Thanks for listening to today's Power Hour episode. The Power Hour is actually owned by the Power Practice. Power Practice is a premier concept consulting group who helps practices achieve freedom of time, confidently solve practice issues, and grow their practices. They do this by having coaches and OD consultants, people who have actually done it, been there, and they're ready to help. You want to learn more? Go to powerpractice.com there's a bunch of free tools there. You can also get a whole bunch of information and decide whether it's right for your practice. Again, if you're looking for more time, you're looking to solve complex practice issues or grow the power, practice might be right for you. Go to powerpractice.com to find out more.