The patient journey: “We work as a family team”

How can teams ensure appointments run like a well-oiled ship and foster trust in colleagues and the practice?

Thompson Opticians has two practices in Cornwall, in Liskeard and West Looe, and has seen patients through the minor eye conditions service (MECS) since 2018.

OT asked Michaela Leitso, optometrist owner of Thompson Opticians, and Sarah Sobey, dispensing optician and practice manager, to talk through the patient journey, what goes into a handover, and responding to reg-flag signs and symptoms in triage.

From booking to welcome

During the pandemic, patients at Thompson Opticians were encouraged to book appointments for all activities, including dispensing, repairs, collections, adjustments and troubleshooting, not just eye exams.

Leitso shared that this worked so well, the practice has continued to encourage patients to book ahead: “This means we already know who we are expecting to see and when and it helps the practice to run more smoothly and allows us to prepare better for patient appointments.”

Through the booking process the practice team will verify patient details and record information about symptoms or concerns Leitso said, explaining: “Some of these may lead to booking a MECS appointment instead of an eye exam after discussion with the dispensing optician or optometrist.”

Optical coherence tomography (OCT) is offered on booking, and if a patient is unsure, a note is added for the optometrist to discuss during the appointment and advise the patient on the benefits applicable to them.

Leitso shared: “On arrival to the appointment, patients are greeted at reception by a happy, welcoming member of staff. After booking in there may be some general chat if staff have capacity. This helps patients feel at ease, [and is] important for gaining trust and improving the effectiveness of communication during different elements of the eye test.”

There isn’t just one factor that creates the welcoming atmosphere Thompson Opticians pride themselves on, Sobey suggested, but a combination of friendly faces and a relaxed clinical environment.

“We have a holistic approach to how we present ourselves in practice that makes it a really warm and friendly environment,” she said.

During the appointment, Leitso explained that she prefers to carry out the OCT herself and go through the results with the patient straight away, adding: “This helps the patient engage in the clinical aspect of their eye care.”

The three optometrists in the practice all take a gentle approach with patients, Leitso said, and show “genuine interest in each individual.”

The power of the handover

In the handover from the testing room, optometrists will highlight any refractive changes as well as any discussions held with the patient regarding dispensing requirements – including frame choice, metal or plastic, size, bridge fitting, hobbies and lifestyle, lens type, sunglasses and coatings.

“We’ll also ask our dispensing optician to go through any lid hygiene or dry eye requirements with a demonstration on how and when to use products for better compliance,” Leitso added.

Sharing her perspective as a dispensing optician, Sobey shared: “What I find really helpful is that the patient is involved in that handover – because they are the centre of it.”

This can look like discussing a change in prescription, the reason for the change, if a referral is required and the urgency, and any issues raised.

Sobey said: “Having the patient at the centre of the handover is really important – it reinforces for the patient the outcome of the sight test and agreed next steps and gives me the opportunity to discuss the patient’s needs with them, without the patient feeling that they have to repeat themselves all over again.”

“The handover helps to promote the professionalism between the optometrist and the dispensing optician – that we have distinct roles and a different scope within the practice. It also highlights our patient-led care approach,” she added.

Managing MECS as a team

When it comes to MECS appointments, Leitso reflected that these often present as patients wishing to book an eye exam “but describing symptoms requiring a more urgent appointment instead of general ophthalmic services.”

Sobey explained that when patients phone or walk in, one of the first questions the reception team will ask is whether they are calling for a routine appointment or if they are having any problems.

She explained: “If they are having problems, it gives us an opportunity to ask about the problems they are having and determine any red flags.”

In these cases, reception staff will undertake a brief triage to determine if the duration and types of symptoms qualify for MECS.

If booking MECS, the practice team use a combination of the Association of British Dispensing Opticians triage forms and Pharm Outcomes, the latter of which produces a recommended timeframe for review which reception staff use to select an appropriately time-sensitive appointment.

Sobey noted that all staff receive triaging training in-house, however: “If it’s outside their remit or they are not sure, they know they can pass it on to someone else.”

If staff are uncertain, queries are first directed to Sobey, then the optometrist.

Sobey explained that she is often on the shop floor and available to answer questions, adding: “It is a small practice so I’m always in earshot. I can pop over to support if needed. It works really well.”

This can also help to reassure a patient that their concern has been heard and will be looked into appropriately. Sobey said: “We encourage the staff to tell the patient if they aren’t sure: ‘I will go ask someone and come back to you.’ It helps the patient to feel valued and that we are taking an interest in their eyes.”

Leitso said: “All staff take an interest in the outcomes of these appointments, and some discussion will take place around triage questions and any useful additions to help with future triages of patients with similar presenting symptoms.”

“The most common MECS appointments we see are flashes and floaters and red eye,” she added.

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Leaning into different needs and skills

The independent practice is based in a small town surrounded by a lot of outlying villages, and has a long history of serving the local community.

This means some patients have been attending the practice for a long time and both expect and rely on seeing familiar faces for continuity of care, trust and rapport, Sobey explained.

The dynamic of the practice team is like a family, Leitso told OT: “We work as a family team and offer a friendly, safe, happy and helpful environment for all patients – whether we see them every couple of years or every month for drops, adjustments and broken spectacles (usually for boys under 10 years old).”

“Some patients just like popping in to say hello, and many will want to be acknowledged when we see them around town. It helps us all to feel part of the community,” she added.

Central to the team’s dynamic is an acknowledgement of the different strengths each individual brings to the practice.

Leitso said: “We are aware that each of us has different skills to offer and we aim to take advantage of those skills – whether tech-savvy, patient troubleshooting, focimetry, admin and clerical, and stock control.”

Sobey explained that the team encourage each other in their separate roles and skillsets, but are also encouraged to take on different roles and are able to step in and help in different areas of the practice.

“It means someone can always help out and no one feels alone,” she explained: “It is important that we all feel valued and that our unique skills and personalities complement each other.”