Onboarding For Eye Care Technicians with Jane Shuman

We break down why technician turnover stays high in busy eye care clinics and how better hiring and onboarding fixes it. We share practical ways to validate skills, build a consistent training program, and create a culture where new techs feel confident and seen.

• shadowing candidates before an offer to confirm fit 
• verifying “experience” by checking how skills are done 
• using behavioral questions to test judgment and critical thinking 
• watching for early red flags like boundary issues 
• giving new hires tools fast, from abbreviations to clinic layout 
• shadowing full comprehensive exams to learn the why 
• avoiding trickle-down training by assigning one trainer 
• building weekly feedback into the first weeks 
• cross-training to improve teamwork and patient consistency 
• ramping skills slowly with paired support for complex tasks 
• recognizing effort so technicians do not feel invisible 

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Transcript

Welcome And Why Techs Leave

SPEAKER_01 0:01

Greetings and welcome to iCare Leadership Live. This is the podcast for iCare leaders who want to level up their leadership, create better cultures, and improve the financial results of their clinics. Now, let's join the show. Welcome, Jane, to iCare Leadership Live.

SPEAKER_00 0:22

Well, thanks, Mike. I appreciate you asking me to have this little chat with you.

SPEAKER_01 0:28

Absolutely. Absolutely. Um, well, you know, after we after you and I talked the other day, it it seemed like, you know, we really should talk about this subject of onboarding technicians into your practice. I uh, you know, I I help practices with HR stuff. And so when someone leaves the practice, I'm often involved. And when we're trying to find someone, I'm often involved. Um, but I'm not usually involved with, you know, the training and the getting them acclimated and and all of that stuff. But that is a really important part of the process, right?

SPEAKER_00 1:05

It's a very important part of the process. And as I travel around, what I find is a common theme that we've got all these new technicians and they keep leaving. And it's so hard to train while you're using while you're while you're having a full clinic of patients. And I couldn't agree more. So part of that frustration uh of why they're always leaving is they're told what to do, but they're not understanding why they're doing it, what they're looking for, and and in many cases, there's a lot of criticism that is not taken constructively. So when there we onboard two different types of people, one with either optometry or ophthalmology experience, and those, and more and more of them are let's hire the right people, we can train them. Well, yes, if you have a training program, but let's first talk about the people that are coming in

Validate Experienced Tech Skills

SPEAKER_00 2:18

with experience. In either case, whether they're naive or have some work under their belt, they need to shadow your practice before you give them an offer because it may not be what they're looking for. I recently was in a client's office and one of their more experienced techs was leaving after many years because she didn't want to work so hard. So she was going to a lower volume where she could tech and not do, at least not yet, do any of the side jobs that she was currently responsible for. So occasionally you get that. But it's it's hard to know when they say they do all the skills. Are they are you speaking the same language? So in that case, it let's take refraction, for example. There are some auto-refractors now that will come up with a glass descript or a potential glass descript. There are, then you have the at the automated systems, where it's a full process that is right on the screen in front of the operator, which is which is a great way to train somebody to refract if they have no background whatsoever. Then you have the manual four opters, and do they know if they're refracting and what is the difference between plus and minus cell? So it's just by asking if they refract, yeah, I refract, but then you put them in front of a foropter and they say, What is this? Right? So, so let's make sure that we that the the people with experience are doing things the way you expect them to be done. Another example of that is tonometry. Okay. Are they using one of the handheld instruments, or do they truly know how to acclimate? And these are both um higher level skills. So, and more and more practices are embracing the either the total pen or the eye care. So, yeah, one is one is easy, one takes time to learn. So it's okay if you know what their areas that they need help in are, and you can focus your training there. But to come in and expect that they're doing it all the way that that you expect them to be doing is not realistic.

SPEAKER_01 5:05

Yeah, so it's sound. So this is a, I mean, we've you've dropped a bunch of useful tips already right here. Just, you know, talking about finding the right person, understanding what their level of knowledge is. And, you know, the resume might say, you know, eye pressure testing and and refraction. But as you said, those could mean totally different things depending on the clinic clinics they've worked at in the past and your clinic. And so hiring the right person is really key. And then, you know, it sounds like understanding their background is probably really important for training and onboarding, right? Because you need to know what you're starting from.

Hiring Brand New Technicians

SPEAKER_00 5:50

Yes. So so let's address the people who are coming in with no experience. How do we assess what they are that they're going to be capable of doing the job? First of all, when when you first greet them, let's let's say they actually show up for their phone interview and they come on site and do they have a firm handshake? And more importantly, are they looking you in the eyes and are they smiling? Um, yeah, I I once wrote an article for administrative eye care, which which ASOA later used as a quote: We are in the eye business, therefore they should be making eye contact. Um and so what that gives you a feeling of are they a people person or are they insecure? It may it may mean that they're going to be a good employee, but maybe not the position that that they're applying for. So great questions to ask people like this. I like behavioral style interviewing, but a great question is anything that would involve critical thinking. Okay, it's not just enough to do the job, especially when when you're a technician, right? Because there's so much that the patient is saying or not doing, not responding to, that may lead you to another test that will help your doctor make the diagnosis. So a great question to ask is, and I got this one from my own PCP, you are at the front desk, and and you don't have a call center. So the front desk is challenged with answering phones, checking people in or out, and other tasks. So you've got a person that walks in, approaches the desk, at the same moment the phone rings, and simultaneously a provider comes up behind you with a question. And what order do you address these?

SPEAKER_01 8:22

I'm not sure I would know how to answer this. You know, I would like to think that the provider would understand that you put both of the other two people before them. Um, you know, we're here to serve our patients. And probably that person that's in front of you is the more important person to address, but that's just my my gut reaction.

SPEAKER_00 8:48

You're absolutely right. Okay. We address that person, right? We address that person to say, Welcome, let me put this caller on hold. You answer the phone and say, This is so-and-so. Yeah. Can you hold, please, and wait for the answer? And then tell just look at the doctor and signal, I'll be right there. Um, so that that yes, the person in front of you is always first.

SPEAKER_01 9:24

Well, you you put you you almost stumped me there, Jane, but I was able to wiggle my way through that uh response. But yeah, that seems like a good question to ask someone in that type of position of, you know, or at least to hear how do they think through it. You know, maybe they don't answer exactly the same, but you get to kind of hear their thoughts about how they how they get through that, maybe.

SPEAKER_00 9:47

That and then you can also um ask them to give you a situation where they did something wrong, whether it be at school or at home or um at work. And what did they do? Were they accountable for their actions? Or they let somebody else find out. Um, and hope or hoped it it just went under the rug unseen. But accountability is so important, and the willingness to learn and question is is paramount. I've been in this industry for so long, and I'm still asking questions because we encounter things, and there are so many new diagnostics and treatments that we may not have encountered them in our own practices.

SPEAKER_01 10:46

You know, I'm so glad you said that because I often notice that same thing with all jobs really in the in the ophthalmology practice, but especially technician, is this person naturally curious? And I always saw that as a good sign if a person was reading a book or had taken a class or had done something on their own initiative, you know, not even at work, right? Or maybe they're job, but like they're a person who just likes to absorb information.

SPEAKER_00 11:21

So this is one of the reasons that I like the potential hires to come back in shadow. Because when they're interviewing with the management or the supervisors, they're on their best behavior. So then if you put them in the position where they're now with the people that will be their peers, they let their guard down. So they might be looking bored in the observer chair, or they might be asking questions after the patient has left the room, or on a more personal level, you get sometimes you get TMI, which indicates that they have some health issues, or they're they're recently separated and they're going to be a single parent, and they haven't yet figured out their child care. These these are all rent flags. Um, and and so then you have to get the the hiring team has to determine from the feedback of of their current staff, is this someone that you want to work with?

SPEAKER_01 12:41

Yeah, sometimes those um, you know, when people give that TMI, right? And they I've heard people say all kinds of things. And um, to me, that kind of indicates a boundary issue, right? So this is a person who doesn't know when it's okay to share things. And when they get on your staff, they're gonna really share some stuff and do some stuff that goes well beyond if you're willing to do that on day one before you're even hired. What are you willing to say and do once you're already on the team? And that's like a boundary pusher type of person. Hey, I don't want to really hear about that. You know, we just met, you know. This show is sponsored by Seasoned Advice HR Services, where I help eye care businesses to make more money and save more money by hiring better, retaining better, and reducing your HR risk. If you would like an HR assessment or ongoing HR support, please reach out to me at seasoned-advice.com.

Build A Real Training Plan

SPEAKER_01 13:50

So we've already talked about really some good tips for determining if someone's gonna be a good fit or not. Let's say that we've made our decision, we've decided we're gonna make an offer to somebody, and now we've got to we've got to get them like acclimated and trained and into our practice and effective. How how critical is that? Period.

SPEAKER_00 14:18

Sorry. Sorry. So that if it's going, it's similar to going to a foreign country and not speaking the language. So they probably don't know their right eye from their left eye in terms of of medical ease, right? O D and O S and O U. So they need they need to be given the tools to do their job. So what are they? Might be at the beginning lists of abbreviations. It might be obviously staffing and and the layout. Don't forget to tell them where the bathrooms are and introduce them to everybody in the staff. And of course, all the regulatory stuff. That's all in the early, the early stages. And then they should just observe and take notes. Observe a tech, try, try to shadow a patient, a brand new comprehensive exam, not even an evaluation, but comprehensive exam from start to finish, including shadowing the doctor. And do that multiple times and see what kind of questions they're asking, and then start to feed them the rest of their tools. So they should not be shadowing multiple people. What I find in the tech world is there's a lot of trickle-down effects, so that the first person who is the trainer does something one way, and then they go off to another patient and they shadow somebody else. And by the time they get to the third or fourth tech person, they are doing something that's that has morphed into four different techniques. So they don't then they create their own based on a little bit of column one and a little bit of column two, right? But to your doctors, the doctors think that everyone is performing the same way. And therefore, when they're looking at the chart, the same result, the results should mean the same thing to every person. So there really needs to be one trainer, or in a larger practice, multiples who are already doing the work the same way. I when I train tax, I start with the very basics of ocular anatomy and physiology, and then branch out into what commonly present conditions may be for that. So and I ask a lot of questions to get the the repetition of what is doing, and some of these questions as we advance a little bit are more if they're wrong, they're wrong. So tell me why you think that and then correct it because then they're more likely to remember. So in today's society, the the learners today don't want to read a whole book, although I'm old school enough to suggest that. They like multimedia, they and they like snippets, so they don't want to spend 30 minutes reading about an anatomy, but rather they they'll spend five or ten learning about the lens or learning about the optic nerve, and then they can start to apply that to their work. So as they are learning this and starting with basic skills, we need to get feedback from them at least once a week. What this is what I hear you're doing well, this is what I hear you haven't approached. How do you think you're doing? What can we provide you so that you can do your job better? And ultimately, by the end of the first week of training, and they've they've observed the scribes. I mean, even when they're standing around, go to have a doctor just say, come in with me and sit there. And if they can see a patient that they were part of the work of, then they start to put the pieces together of why that doctor's asking different questions or additional questions and what the end result may be. So they they start to see the bigger picture, not just their role in that.

SPEAKER_01 19:29

I love that. I love and and I love that that you talk about the why, right? So they understand they may never go into that exam room again, but if they get the opportunity to understand how their work contributes to the things that happen downstream, it makes them more effective, right?

SPEAKER_00 19:55

Totally. And they shouldn't be afraid to ask the doctor a question. So if they've worked up a patient that was, you know, once they get into the in into the general routine and they start to understand, there's no doctors like to teach. And if you show some curiosity, I worked up this patient who had these symptoms I've never seen before. Tell me what that was all about. That you won't forget that in time.

SPEAKER_01 20:36

Yeah, and I think that I think in my experience, the physicians they like to be around staff members who who want to know, you know, like you said, they want to teach, they want to explain, and and I think they they intuitively know, hey, if this person understands on a deeper level, then they'll be more effective, you know.

SPEAKER_00 20:57

Yeah, and now, you know, there's what when I was learning, I had the staff, I had my book and whatever tools and resources they gave me. But to now, to the really curious, there are some great websites um and YouTube, and that they can just go and and research. And a lot of that is written in lay persons terms so that you don't have to be experienced to understand what they're saying. I remember I used to read the uh the patient education brochures, the caught, so doctor would um order a laser, let's say a YAG capsulotomy, right? The the the clouding of the posterior capsule behind the implant. I didn't know what he was talking about. I picked it up and then, oh, okay. So he's gonna shoot this little hole so that the the vision is not blurred at the end. Again. Made sense. And then I could explain it to the pensions.

SPEAKER_01 22:06

You talked about introducing new hires, you know, to other people in the office. And

Team Culture Through Cross Training

SPEAKER_01 22:13

I wanted us to hear you talk a little bit about the importance of socially integrating new hires and new technicians, you know, not just the technical stuff, but like what is the tell me about the element of social integration?

SPEAKER_00 22:29

It builds teamwork. I there's no question about it. And if they understand that no job is less important than another, they're more willing to learn what those other people do. I mean, I'm a huge proponent of cross-training, no matter what the size of the office. I mean, I cross-trained years and years ago. I was in a small office. There were 13 of us. And when somebody called in sick, no matter what the position, we had problems. So I cross-trained my text to answer the to scribe and then to answer the phones. The scribes then learned to tech or answer the phones. And ultimately, the three, the front desk, the scribes, and the text were all one. And we could pull from one area to another to get that area caught up. For instance, the uh the first thing we taught uh the front desk people was to do a visual field so that they could come off the field off the desk for 20 minutes, and then later on a tech could help answer voicemails. So that we became very self-sufficient. And what we didn't expect out of this was that the patients got into it. They knew once everybody was cross-trained, the patient knew whoever they spoke to, they got the same answer from everyone. The triaging was pretty consistent. And then they the the frequent flyers, the regular patients, would come in and they'd say, Oh, you're on the desk today, or you know, what's so-and-so doing today. And it it was great. It and it built a lot of understanding of what makes the office tick.

SPEAKER_01 24:42

Yeah, I think that's really, really powerful. Just from and even, you know, from a job value standpoint, you know, if I'm an employee, I've what from what I've seen is the best employees, they want to know. They want to know what other people are doing, they want to know how this whole crazy clinic works, and that kind of feeds into their intrinsic motivation, from what I've seen.

SPEAKER_00 25:08

And I think a full exam, including diagnostics, should be part of the orientation period at the end of the 90 days, and you know that that person's gonna stay. So now when somebody approaches the desk and they say, Are they doing that thing today, that one or two, they know that yes, you're going to be getting a glass of prescription today. So they've got more confidence in in the whole process.

SPEAKER_01 25:39

Are you talking about having the the employee go through the process of being a patient? Yeah. I love that idea. And it gives people empathy, you know, for what it's like to go through because some of the processes can be pretty long or or uh maybe uncomfortable or what have you. And maybe they even see things that that gives them ideas for how we can improve the practice.

SPEAKER_00 26:06

For sure.

SPEAKER_01 26:08

Yeah, I've seen I've seen that happen.

When Onboarding Starts To Fail

SPEAKER_01 26:10

I'm wondering, you know, sometimes we bring on a technician and it doesn't look like it's going well. It doesn't go well, right? You've seen that. Um is it always the new hire? Is it always the new hire? And what do you do? How do you how do you determine that?

SPEAKER_00 26:33

So it's not always the new hire, but it's more likely to be the new hire. If they become friendly with the classic pot star in the office, their morale, their their attitude may change. If but but if they can't get the job, right? They they're out you when they come and they ask the same question over and over and over again, by the third time, I would say, what do you think you do to make sure because they're not confident, right? So again, there's that critical thinking part. Sometimes, and I and if they continue or they're going to somebody else, then we do have a problem. But they might be a good employee, they might be showing up on time, they might have a great worth work ethic and want to do it, so they may not be able to see the big picture. So they might not be in the right seat on the bus and need a different department, or you start them with a repetitive task, you put them on visual fields, okay, until they master it, understanding the errors and getting a reliable test, or the same with OCTs. But they again they need to know what they're looking for, why the patient is doing it the way they're doing it, and what does abnormal look like? Right? We know we can recognize normal, but what does abnormal look like? And then let's find out what that is. So if they excel at that, then you can bring them on more gradually. So for for your new techs that are are learning workups, okay. What I I suggest is that you start them slowly and get them to the point where they can do a short workup or a post-off, because that way they can be productive and you can pair them with a more senior technician so that once the the short workup part is done, they're working next door or across the hall from each other, and then they flip-flop so that the more experienced one comes in and does the advanced skills, and while the newer one takes another person, another patient in and get them started. And and so it just grows slowly.

SPEAKER_01 29:30

Do you think that sometimes the new hire just needs like a different method of training, or maybe they're just not gelling with the trainer? Is that a valid thing?

SPEAKER_00 29:46

That is a valid thing. So many of the trainers, that job is given to the best technicians. The best technicians have lived this so long at second nature. So the best trainers are those that can re have some emotional intelligence with who they're dealing with, and perhaps change their language, explain it differently. I've seen that work quite a bit. I've even worked with experienced techs who have some holes in their training, in their foundational knowledge, or in their refraction training. And it's like, oh, now I get it. That makes so much sense. I've been doing it without understanding it for so long. Yeah.

SPEAKER_01 30:48

Yeah, I have I've definitely seen that sometimes that you know there has to there it's helpful if there's a good connection between the trainer and the trainee. And you're right, it's not always that best employee, it's the person that understands, has a better mastery, and has a good skill at communicating and empathy. Yeah.

SPEAKER_00 31:10

I very often will use analogies that don't relate to ophthalmology, right? And oh, okay. So, like for explaining glaucoma, the different glaucomas, a sink faucet and a basin, right? Is it is the water backing up or is it draining at the same rate? Oh, okay, yeah.

SPEAKER_01 31:36

I might need those analogies because glaucoma is is something I haven't had a lot of exposure to. So we'll have to we'll have to chat about that, those analogies.

Recognition And Modern Learning Styles

SPEAKER_01 31:46

Fair enough. You know, you talked about appreciation, the importance of appreciation and positive, you know, reinforcement. Do you think that do you I'm curious if you think that the desire for that has changed over time? And whether you think there's validity to the idea of generational differences that you know what new techs these days are different from new new techs, you know, from let's say 20 years ago. Do you think how you train and you do you think there's differences?

SPEAKER_00 32:22

There's definitely differences, but let's go back to your point about appreciation. Sure. I don't think that has changed. I think for a doctor at the end of the day to say thank you or to acknowledge that a workup of a difficult case or difficult patient was handled really well, that goes a long way because very often, especially the new hires, feel that they're being picked upon, right? But but we need order and we need consistency. And the only way we're gonna get that is to point out the the what could be done better. But when the providers acknowledge it and the managers acknowledge it, it's really important. Every doctor should know who is working for them. And even at the desk, a large I once hired a tech who said the the previous practice the doctor didn't know her name. Well, that that speaks volumes.

SPEAKER_01 33:38

Yeah, being invisible is is one of the uh one of the horsemen of the uh turnover apocalypse, I think. It's like not being seen as a person. Okay, so appreciation is one of those enduring um things that you need to do. What do you think do you and so you but you then you also said that there have been changes over time in in onboarding and new hires and maybe how you train them, do you think?

SPEAKER_00 34:09

I do. So, first of all, there's so much more the workups are more complicated, alone from electronic records, right? So that's another area that they need to learn. Me, I I started, I just wrote things down, right? Um, but now they need to know how the system works and their role and the doctor's role in that as well. So technology has certainly changed how we learn. But you mentioned the different generations, and this is where those snippets of education come into play because we're we're so accustomed to multitasking, right? Everything's done really quickly, so let's just feed them at the same time and mix it up. So we've got some verbal, we've got some written, we've got some YouTube in there, we've got some observing on our own. And then once they seem to have gotten that, then it's time to start mixing in skills, right? So that they can become functioning.

Resources And Closing Takeaways

SPEAKER_01 35:38

Awesome. Well, I think we've you've you've shared so many helpful tidbits here with us, Jane. I loved every minute of it, and it so much of what you talked about really was beyond just the technical aspects of onboarding. It really touched on the cultural aspects of what it means to connect with another person and match that person to your business and to help them feel valued. We talked about appreciation. And um, this is as we said at the very top, this is such a critical process, um, an important time. And as you said, also we see a lot of times where technicians come on board and then they leave. And that's a painful and costly thing. And so you shared so many awesome things with us today. Yes. How can how can people get in touch with you or learn more about your work if they want to connect with you?

SPEAKER_00 36:42

So by all means, start with my website, itchs.com. The information is is all there, including how to how to reach me personally, or you can go to info at iTechs.com. That also comes into me. So I'm happy to answer anybody's questions. And I want to thank you for the opportunity.

SPEAKER_01 37:06

Awesome. Well, Jane Schumann, thank you so much for your time. And if anyone wants to get in touch with Jane, I'll put the information in the show notes so you can just grab that from the comments section of the show notes. But that's that's going to be our show today. Uh, thanks for everyone who attended or uh has listened to the show either live or on the recorded version. Well, that brings this episode of iCare Leadership Live to a conclusion. If you enjoyed this episode, please subscribe to the show on your podcast app and share it with someone who would value the content. I promise to bring you more guests and content to help make you a better iCare clinical leader. I also invite you to subscribe to my HR newsletter for iCare leaders. You can find information about that at seasoned advice.com. Now go out there and lead with confidence.