Running a perfect clinic

Take-home message: As staff members develop in new roles, managers should coach and counsel them in the direction where they are thinking and making decisions in a global manner, not an individual manner.

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

I can be considered a “sportsaholic”!

No matter what season of the year, I will be fixated on a sport and the teams/politics involved. Baseball owns my heart. While most folks bravely trudge through one Fantasy Baseball team, I proudly manager three!

Every morning on my way to work, I am glued to the radio making sure to get the latest updates on the games played last night, and the pundit’s philosophies of the teams in question.

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One show I listen to is the “Mike & Mike” Show, with Mike Greenberg and Mike Golic. They have good banter, comedic discussions, and excellent analysis of sports. Greenberg plays the absolute antithesis of a “rough-and-tumble athlete,” and Golic is the ex-football player who “has done all that.”

One day, they were having a passionate discussion of a recent game, and Greenberg called out in angst the following statement: “Don’t let perfect be the enemy of good” (originally credited to Voltaire).

I arrived at work, shut off the radio, and entered my own sports arena of clinic life. I thought back on this statement periodically throughout the week, and began to have an understanding of what Greenberg might have meant as it related to my world.

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We have recently changed lead technicians/lead locations in six of our clinics, and while it has gone relatively smooth in the past month, I am beginning to see the “shine” wear off.

When you make a large clinic change, there will be a grace period where tolerance of all the staff will be high. Misjudgments, miscalculations, overreactions to situations, and napoleanistic behavior is often overlooked or diminished, and all sins are quickly forgiven. This can also be called the “honeymoon period.”

Next: The branching-out phase

Then we begin to see the branching-out phase. This is where staff members-feeling comfortable with their new roles-begin flexing their wings.

An example of this occurred as I was trying to make a staffing change on the fly-literally, I was at the airport running between gates to connect with my next flight-because we had a last-minute sick call in the clinic.

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Shawn, my new “right-hand” lead, informed me of this spur-of-the-moment sick call. Using this as a teaching moment for Shawn, we began reviewing the situation and what it meant throughout the system:

• We needed to look at four other clinics and the dynamics of those clinics, and also the clinic that was now short . . . as well as the lead running that clinic.

• We looked at the dynamics/demeanor of the physicians at the short clinic.

I decreed that one of the technicians, Sara, needed to leave Shawn’s clinic and go to the clinic that was now short. Shawn was to inform Sara, and the case was closed. Or so I thought.

Fifteen minutes later, Shawn called to tell me that instead of sending Sara, she had sent Peggy.

I was angry for a number of reasons, but tried to temper this so I could try and help Shawn understand the many errors of her ways. She felt she had made an educated decision. While it was educated-it was also ill timed, slightly ulterior, and poorly executed.

Peggy is a sweet-tempered and patient technician, but she is newer and still slow with her skills. Going into that fast-paced, crazy clinic was not what I had envisioned. Basically, it was a very poor move and it set Sara up for a pretty scary morning.

Next: What went wrong?

While you might feel it is good to have the lead thinking ahead, what she really did was:

•  Look at how her clinic was being slightly stretched, and decided to keep the strong technician (Sara) that I was sending away and instead sent the “weaker” technician (Peggy)-thereby, her clinic remained strong and “excellent.”

• Involve two other clinics (making a complicated four-way switch versus just a simple two-way switch). Now there were technicians all over the road in the early-morning, rush-hour traffic.

• Put a new person, who was being sent to “save the day” in the potential line of fire.

• Override me, and then informed me of it after the fact. There was no changing it after it was done.

Throughout the day, a discussion commenced of where Shawn had gone astray, my perception of why she did this, and the errors of her thinking.

I absolutely need and want her to be thinking and making decisions, but in a global manner not an individual manner, thereby ensuring her clinic world was running perfectly.

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Instead of everyone having a chance to run “good” on this crazy morning, she jettisoned two clinics so they ran minimally “fair” and then ensured her clinic ran perfectly. Sometimes good for all is better than perfect for one.

The leads/managers will begin to do things quietly below the radar to ensure their clinics run smoothly, and that they remain basking in the glow of success, even if it is at the downfall of someone else. This cannot be allowed to occur

Managers/leads need to be thinking constantly of the whole picture and not just the small, individual frames of snapshots.

I am not saying these are heinous, premeditated acts to tank other leads-because they aren’t. It is human nature to survive, and to them, they are simply surviving.

You may see another example of this in this instance:

Every time you call a clinic, Angie, a general technician, answers the phone instead of the lead technician. When you ask where the lead is, you are told he or she is in a room seeing a patient. When you ask the lead “why” the general technician is always answering the phone or the physician’s bell, the reply will be: “We were behind, and I am faster than them, so I had them ride the desk.”

Instead of correcting, mentoring, and advising Angie to improve her speed, the lead “hides” her at the desk and pushes her to the side. All is well, but Angie is failing.

Lastly, there are going to be times when all hell is going to break loose. It happens!

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Help the leads understand it is just a ripple in the water, and help them learn how to get out of the nightmare day they are having. Teach them how to raise the white flag and how to re-assess what has occurred.

Being oblivious to it, or trying to hide it, is like putting a pink dress and high heels on a grizzly. While you may be able to dress it up, you still have an angry bear running around in the clinic.

When I return from the weekend, Shawn and I will need to go have breakfast and discuss why she received my wrath. We will discuss that while “good” would have been the best outcome for all involved, she had basked in the glow of “excellent” at the sake of her fellow technicians.

I am sure there will need to be a Bloody Mary involved as the first course-at least for me!

Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Dianna 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.