Failure to deliver the best care and services because one person is out sick is not acceptable. It is costly to your practice, and avoidable through cross-training. Our four-OD, 19-support staff practice, which delivers over 6,000 exams per year, has found cross-training to be an effective way of ensuring consistent care.

In addition to consistency of care, cross-training also has allowed us to provide staff with opportunities to grow in our practice. Sometimes we find a staff member has a great desire to learn something new, and occasionally, we may find a staff member has a strength that we didn’t realize until they performed another task in our office.

The staff of Miamisburg Vision Care delivers consistent care to patients, thanks to cross-training. Each is trained in a primary task and at least one secondary task. There is no disruption to patient service and flow when a staff member is out sick or on vacation

Along with the benefits to our patients, cross-training helps us keep our staff happy, as they feel more valuable, and experience joy when they find something new they can become an expert in.


In deciding what tasks to cross train, we first reviewed the areas where we already had challenges throughout our day, but also looked at situations in which the variables can’t be controlled, such as when patients come in late causing a bottleneck in pre-testing.

In those situations, having an additional staff member who can step in and do pre-testing is beneficial. Or having another employee who can pinch hit in the optical when the opticians are backlogged can mean the difference between making and missing a sale.

As another example, it would be great to have everyone trained in all areas, but working with the billing, and reconciling an EOP, is not critical to patient care. So, be sure to prioritize in cross-training areas that most impact patient care, or those that patients perceive to be something that should not include significant waiting, like scheduling an exam or picking up contact lenses.

It is important to continually expose your staff to the secondary tasks you would like them to perform, so the skills stay fresh in their minds.

Our personnel manager is responsible for setting the schedule to ensure each staff member is placed in both their primary and secondary tasks throughout the upcoming week. We always have in place a back-up for key tasks in case an employee is absent. After the daily schedule for primary roles is determined for the upcoming week, we then decide who the back-up employee will be for each of the key roles in the office for each day. It’s like having an under-study at all times for each essential role in the office.


It can be challenging when an employee finds their primary task is not what they want to do, and they would rather perform their newly learned task. We prevent this from happening by having a clear conversation with the staff member to set expectations and the purpose for learning the new task.

For instance, we told an employee, who was a scribe and pre-tester, that we needed her to learn contact lenses since one of our contact lens technicians was going on maternity leave. We clearly indicated that she would be working as a scribe, and that was her primary role, but we also were having her learn contacts to ensure we could maintain consistency in patient care for contacts. The other thing we did was to provide scheduling to allow her to work in both roles once the contact lens technician came back from maternity. She was thrilled to be able to work in both roles, and this allowed our practice to maintain the excellent care without the patient suffering or waiting because we couldn’t handle their needs.


The importance of cross-training is it ensures there is no change in the care you provide every patient, regardless of who is sick or on vacation.

Staff should always have, at a minimum, a primary task with a secondary task, and possibly other tasks they learn well enough to perform when necessary. What If only one person can take retinal photos, or run ancillary tests, such as a visual field? At the worst moment when a field is needed for patient care, you can be stuck making the patient wait while performing the task yourself. Or what if somebody decides they want to try contact lenses, and needs training, but your primary trainer is gone? It is much better to be able to help the patient right then versus having them come back. This works for all areas, like dispensing glasses or contacts, scheduling patients, or patient pre-testing.


The time needed for cross-training varies, but can be done in many ways. A big thing I do in my office is include training during our weekly meetings. This generally means we break up into groups and the person who has the best knowledge of a primary task will teach someone the task as their secondary responsibility.

We also make sure that whenever an employee is not needed for their primary task, they shadow the employee doing their secondary task. For example, an employee who normally performs contact lens training may follow the visual field tester if there are no fits being done at that time.

There also is continued training during the course of a typical day by the personnel manager in my office, on-the-job, as the need arises.



Partner Miamisburg Vision Care, Miamisburg, Ohio

Dave Anderson, OD, is a partner withMiamisburg Vision Care in Miamisburg, Ohio. To contact:


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