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EW NEWS & OPINION 36 September 2016 by John B. Pinto and Corinne Wohl, MHSA, COE • Using an assistant to handle personal banking, travel arrange- ments, dry cleaning, and other chores; and • Having a driver for outreach clinics, leaving the surgeon free to dictate, make calls, or nap. Better delegation habits also extend to the home front, where the use of live-in child care, house- keeping, and cooking is not a luxury but a necessity for two-professional households. Remember, there's a third cat- egory some of your tasks may fall under: those things you do today that NO ONE needs to do. Are you reviewing reports and data that you don't use to make business or clin- ical decisions (you just read them out of habit or curiosity)? Are there blogs or websites that you have bookmarked and review every day out of habit, but that provide little more than entertainment, wasting precious productive time? Do you thumb through publications you get—but don't really get much out of—out of guilt that you've already paid for the subscription? Start sub- tracting these time sucks from your daily routine. EW Don't try to make this an exhaus- tive list of everything you do, just use it as an exercise to limber up your thinking and help you realize that almost everything you do falls into one of these two categories. 2. Next, examine those right-column items. Some of these you may still want to do, even though some- one else could do them for you; perhaps you enjoy the down time of driving to your satellite office or personally calling patients after surgery. For things you would like to try to delegate, write down who you could delegate to. These could be people you currently employ or outside service resources you can hire by the job. 3. Then, write down how much time you would save if you delegated these items—and what you would do with the time. Would you see more patients? Or spend more time with the ones you have? Would you use the time saved for continuing education, exercise, or similar self-development? 4. Last, commit to delegate, and get to work. Gather the people who can help you do this—your administrator, perhaps your lead tech—show them the right-col- umn list, and continue the brain- storming as a group to expand the list. Then follow through. Consider these often-overlooked delegation opportunities: • Teaching your smartest technician to perform lens calculations (with your subsequent oversight); • Delegating more patient education and question-answering to techni- cians and scribes; • Making sure each technician is doing all he or she can to ease the provider's work: completing a deeper history, handling all refraction and dilation chores, even adjusting the slit lamp to the right height before the provider's examination; • Teaching the staff bookkeeper to gather and analyze the key perfor- mance indicators of the practice each month, digesting this into an at-a-glance report; • Calling a clerk into board meet- ings so the managing partner and administrator can focus on the proceedings instead of taking notes; • In the present cost-sparing envi- ronment, some surgeons no lon- ger have enough reserve capacity on their teams to absorb extra work. • It's faster and more efficient (at least for today) to just do some- thing yourself than teach some- one else how to do it for you—of course, that argument breaks down over longer time frames. Curing "delegation deficit disorder" Living nose-deep in a hectic private practice can make it hard to recog- nize how much you are doing for yourself that you really could dele- gate. It helps to step away from the office and in a quiet weekend hour reflect on your core duties and those you can off-load. Here's a useful exercise: 1. First, write down things that you routinely do in a week, and break this list down into two columns: Things that only I can do Things that I could delegate See patients in clinic Write consult letters Perform surgery Call patients the evening after surgery Review business statistics Gather and assess business statistics Chair board meetings Draft board meeting agenda M ost ophthalmologists are less effective dele- gators than they need to be, which leads to professional inefficien- cy, under-used staff resources, and provider burnout. We have observed a clinic in which the surgeon, upon failing to find forceps in Room 3, walked from room to room hunting one down, while the patient patiently waited back in Room 3. All the while, there were two techs at the nurses station, ready to help out, but unbidden by the surgeon. (Exactly why there were no forceps in Room 3 is another mat- ter and a topic for a future column.) In turn, through such do-it- yourself behavior, ophthalmologists often create organizations with similar bad habits—with administra- tors drowning in tasks, not handing them out for others to help with, and department supervisors who hold on to junior duties "because we never seem to have enough time for training." There are several reasons—some generalized and some specific to medicine—for why doctors and their subordinate practice leaders don't delegate well: • The standard of care in medicine, and the understandable culture of medicine, is "perfection." It's inhibiting to delegate when you have been trained and attuned to perfection. • Medicine is largely a solo sport. All day long you are acting unilateral- ly on each patient's behalf. To the point: Simple practice tune-ups for complex times Delegation: The key to effective management Mr. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979, with offices in San Diego. His latest ASCRS•ASOA book, Simple: The Inner Game of Ophthalmic Practice Success, is now available at www.asoa. org. Mr. Pinto can be contacted at pintoinc@aol. com or 619-223-2233. Ms. Wohl is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her Masters of Health Services Administration degree at George Washing- ton University and has 30 years of hospital and physician practice management expertise. Ms. Wohl can be contacted at at czwohl@gmail.com or 609-410-2932. About the authors

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