Leadership

Key-Whitman: taking the lead

Lessons from the Dallas practice that excels in patient care, technology, compliance, clinical trials and employee satisfaction.

BY VANESSA CACERES, CONTRIBUTING EDITORPHOTOGRAPHY BY JASON PENDLETON

Pictured are some of the members of the Key-Whitman team, clockwise from top center: Pat Colerick, OD; Dena Perez, optician; Lori Green, LVN; Danielle Wood; Maria Cervantes, front desk supervisor; Kellie Leath; Stephanie Bryan, administrative manager; Shawn Pendleton, COA; and Ruby Armijo, COA (center).

With seven locations, 16 doctors, and about 200 employees, Key-Whitman Eye Center is an ophthalmic leader in the Dallas metro area.

Yet it’s not remarkable only for its size. It’s also a leader because of its innovations within patient satisfaction, intraocular lens (IOL) technology, compliance, clinical trials and employee satisfaction. Here, Key-Whitman staff members describe why the practice stands out — and what others in ophthalmology can learn from their experience.

Reducing patient wait times

Waiting a long time to see a doctor can affect patient satisfaction, especially when the patient perceives the wait time as unreasonable.

To help remedy this issue, Key-Whitman began to use radio frequency identification (RFID) tags a few years ago, says Dan Chambers, MBA, COE, chief administrative officer. Such tags are used in manufacturing, retail clothing stores, or to track health-care equipment. Key-Whitman leaders worked with an IT company, KoreNetics, to implement the use of RFID tags worn by doctors, employees, and patients. Staff members explain to patients that the ID tags allow the practice to easily locate patients throughout the building and reduce patient wait times.

With the tags, Mr. Chambers and other practice leaders can know anyone’s location within the practice at any given time. In his office, Mr. Chambers has four video screens to show different parts of the building as well as satellite locations. In addition, a secondary software program takes the data collected by the tags to identify and make recommendations about potential causes of bottlenecks. Practice leaders then use that information to implement changes to the scheduling templates and to adjust doctors, technicians, exam rooms and equipment to keep the practice running more efficiently.

By using this program and evaluating possible bottlenecks, the practice reduced wait times of up to an hour to less than 15 minutes, Mr. Chambers says. The practice also has been able to add more patient visits per day without the schedule feeling squeezed.

Employees also can get patients out of the office on time before closing, thereby reducing overtime and boosting employee satisfaction, says Jeffrey Whitman, MD, president and chief surgeon.

The system also helps staff members quickly see where employees are when they need to reach them, rather than going on a mad chase around the office.

While Mr. Chambers acknowledges that the RFID system was a “hefty” investment, he says it is increasing practice capacity by 10% to 20%, easily adding 10 or more patient visits per day, while decreasing staff time and costs. The costs have come down now with the cloud technology environment; the system was able to recover its costs in the first year, Mr. Chambers says.

Employee satisfaction

For five consecutive years, The Dallas Morning News has rated Key-Whitman as one of its top-100 places to work in the Dallas area. The ranking is based on information from employees at the organizations on the list. Although it is an anonymous survey, Dr. Whitman is aware that it asks employees about their own happiness in the work environment but also asks for feedback on managers, coworkers and company-wide communication of goals.

With RFID tags (pictured left), Key-Whitman can observe the flow of patients, doctors and employees in real time. Pictured from right, Cecilia Renteria, COA, assistant clinic manager; Dan Chambers, MBA, COE, executive director; and Larry Fish, MD, view tag locations on a video screen.

Creating a productive, happy workplace starts with selecting the right people, Dr. Whitman says. During interviews, managers will look for friendly, smart candidates who do not necessarily need to have a background in ophthalmology. Candidates also take a short math and reasoning test during their interview. “When you think about it, ophthalmology is a lot of optics and working with numbers. It’s a basic test but if someone doesn’t have that basic knowledge, they’ll be frustrated and probably not last,” Dr. Whitman says.

The practice is lucky in that many people are aware of its reputation as a good place to work, so potential employees frequently come to it, Dr. Whitman says. The practice’s benefits — health and dental insurance as well a 401(k) plan with matching funds — also attract people. Also, Dr. Whitman decided to shy away from end-of-year holiday bonuses and instead focus on quarterly bonuses tied in part to how the practice performs. “If the practice didn’t make a profit, we don’t pay a bonus,” he says. However, bonuses are also specific by departments and can depend on the department making its stated goals.

Dr. Whitman believes these bonuses reward people for hard work more than a standard end-of-year approach.

Team building contributes to happier employees as well, Dr. Whitman says. “We recently had a surprise Dippin’ Dots ice cream party. If we have had a particularly hard morning or week, we might buy lunch for everyone that day. Different departments will have happy hours. It’s about team building,” he says.

As part of team building and team recognition, the Key-Whitman staff recently enjoyed another surprise: freshly popped popcorn, courtesy of a popcorn machine that Dr. Whitman brought into the office (see the front cover). Also, Key-Whitman’s recognizes employees on its Facebook page, briefly profiling them and including pictures.

Key-Whitman also emphasizes continuing education with designations, such as certified ophthalmic assistant (COA) and certified patient service specialist (CPSS), which is a customer service accreditation.

One measure of satisfaction is employee longevity. Several employees have been employed at the practice for 10 or 20 or more years. “We have somebody who retired who had been here for 40 years. She was here longer than I’ve been here. That shows me we’re doing something right,” Dr. Whitman says.

Key-Whitman takes pride in using the latest surgical technology. Here, Jeffrey Whitman, MD, president and chief surgeon, operates the practice’s femtosecond laser.

Clinical trials

At any given time, Key-Whitman is involved in several clinical trials, says Susan King, COT, director of patient counseling and research. Right now, the practice is involved with five trials, including one related to glaucoma and the others focusing on presbyopic correction.

The practice chooses which trials to participate in based on the product, the company, any history Key-Whitman has in that particular subject area and whether Dr. Whitman believes the concept being studied could be viable.

There’s been a learning curve to becoming so heavily involved in clinical trials, Ms. King says. The practice had to create its own research department due to the amount of paperwork and scheduling involved. The department includes Ms. King as well as a full-time optometrist, one full-time employee, and another part-time employee. The time during which they evaluate patients for the study is separate from the patients’ traditional exam time, which helps to avoid conflicts with the clinical schedule, Ms. King says.

Identifying good patients for trial participation is an art, Ms. King says. “It goes hand in hand with being a patient counselor. These days, you almost have to be a psychiatrist. You have to make sure patients meet study qualifications, which can be rigorous, but you also have to make sure they will stick with you throughout the study.” Key-Whitman undertakes a number of steps to help retain trial patients, including:

• emphasizing the importance of returning for all visits

• prescheduling all appointments for one year

• sending patients automated appointment reminders by text and email

• following up with a personal confirmation call two days before scheduled appointments

• developing a relationship with patients so they will want to return

Despite the challenges and arduous paperwork, the practice sees real benefits from the trials, Ms. King says. “In the successful studies, we love being the first in the area to provide that to the patient. It’s reinvigorating when you see advanced technology take off,” she says.

Ms. King advises other practices looking to take part in clinical trials to do their homework. This includes getting in touch with a clinical research organization and using the U.S. FDA website to find out what is involved with clinical trial participation.

Premium IOL technology

Key-Whitman offers laser-assisted cataract surgery and a variety of premium IOLs, and plans to offer more as the FDA approves others. Once a doctor identifies a patient who is clinically suitable for a premium IOL, the IOL selection process starts with quality chair time — usually an hour to 90 minutes — with the patient, Ms. King says. She or one of the counseling staff members leads that process.

“We’re good about sitting with the patients and getting to know them,” she says. “They have to understand what a lens will or won’t do for them.” All of that chair time can save a lot of frustration from a wrong IOL choice.

If a certain lens that a doctor thinks would be suitable is not within the patient’s budget, Ms. King or a patient counselor helps the patient find other options that are affordable but that still fit within the patient’s budget.

Compliance, EHRs, and Meaningful Use

To help guide employees through the maze that is electronic health records (EHRs) and Meaningful Use (MU), Holly Lagergren, assistant clinic manager at the main location in Dallas, provides regular training. Much of this training focuses on the questions that must be asked during patient exams to stay in compliance. “To meet the goals, staff members need an understanding of what they need to do and why,” she says.

Ms. Lagergren uses screenshots that are shared with staff members to go over certain questions that need to be answered. She also conducts one-on-one training as needed. Her trainings take place as the EHR system is updated, and her training materials are shared with the practice’s other office locations so their staff implements them accordingly.

Although staying in compliance with MU and the Physician Quality Reporting System (PQRS) has slowed down exam time, consistent training has put the practice in a better place now in terms of staying in compliance. Most of the doctors are now in Stage 2 of MU. Ms. Lagergren advises other practices to review their MU-related data at least once a week to check for compliance and proper documentation. The practice’s conversion to ICD-10 coding has been seamless with the appropriate staff training, according to staff members.

When Ms. Lagergren trains employees, she likes to address not just what they have to do but why.

“We want everyone to become a part of the process versus them thinking, ‘I’m just a button clicker.’ We’re a team here. It takes every single person to be part of it,” she says. OP