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Supervision, management and leadership skills in optometry.

This article considers the importance of and the skills necessary to become an effective leader and how this relates to supervision and management in practice.

Optometrists ****

Therapeutic opticians ***

1 CET POINT

Introduction

The definition of leadership varies from the layperson to academic, even within different scopes of study and professions. This is commonly due to the practice of leadership having distinct styles in different professions. (1) Nevertheless, leadership predominantly involves aspects including: influence, people, authority, change, unified achievement, direction and purpose. Although many leaders are managers, there is a distinction between these roles and it is not always necessary for a manager to be considered a leader. Management entails completing tasks and requires job competence and is usually labelled with a management position within a company, whereas, leadership adds innovation, long-term outlook and emotional commitment. Leaders innovate, originate and develop whereas managers administer, imitate and maintain. (2) It is important to ensure one is a good leader by having a combination of competence and emotional intelligence. (3) Leadership derives from two main types of motivations, related to the task and/or the people. The quality of leadership affects not only on the success of the organisation but also its people and outputs. (4)

For optometrists in the UK, management positions have traditionally been limited unless you are a practice owner. However, increasingly, large multiple companies have started to employ optometrists as managers, whether it is to manage the practice, professionals or other aspects within the company. Large businesses are beginning to realise the importance of having strong optometrist leaders. With the current challenges facing optometry as a profession and its market, the need for effective leadership is apparent. Whether an optometrist is within a managerial role or not, they are key figures to demonstrate leadership.

Supervision

Although management and leadership attributes can differ, supervision is another distinct trait that is generally categorised with leadership. (5) Supervision is an important part of a practitioner's competencies. The GOC recently introduced the Standards of Practice for Optometrists and Dispensing Opticians, (6) which includes detailed clarification of what is expected when undertaking supervision of delegated tasks (See Table 1). The section relating to supervision is outlined as follows: 'ensure that supervision is undertaken appropriately and complies with the law.' (6) These competencies apply to supervision of both pre-registration trainees and unregistered colleagues undertaking any delegated activities. Adherence to these competencies is demonstrative of leadership traits. Practitioners can be supervisors in many ways. Perhaps the most evident form of supervision is as a pre-registration supervisor. Being a pre-registration supervisor is a rewarding role as it allows the practitioner to contribute to the development of the next generation of the profession while also developing their own skillset. Supervising successfully primarily involves guiding and developing skills within the trainee. These skills allow them to recognise and work within their level of competence, and to reflect on, and action, any areas that need development. (7)

The College of Optometrists has published a 'Supervisor Competency Framework' to support supervisors in meeting the GOC standards. (8) It is aimed at helping supervisors to prepare for the responsibilities required to fulfill a successful pre-registration placement. This is in the document 'Supervising for Success' published by the College which is an excellent tool detailing skills, responsibilities and competencies required to be a safe and successful supervisor. (7) As outlined in 2.9.1 in Table 2, it is very important for the supervisor to be adequately qualified and experienced to undertake the supervision. As a result,

it is highly recommended that a practitioner considering becoming a pre-registration supervisor thoroughly reads through this document and attends any pre-registration supervision courses available. Moreover, it is imperative that the professional is aware of the requirements in terms of experience and qualifications to be a pre-registration supervisor. For example, if the optometrist is supervising as a sole, principal or joint supervisor then they must be qualified at least three years from the date at which they entered the GOC register. Further details of frequently asked questions regarding supervision requirements can be found on the College of Optometrists' website. (9) Furthermore, a comprehensive guide to the roles and requirements of the pre-registration supervisor can be found in the Scheme for Registration handbook devised by the College of Optometrists. (10) Other common areas where an optometrist may be taking on a supervisor role is when parts of the eye examination are delegated to optical assistants within the practice. Common delegated tasks include: non-contact tonometry, auto-rcfraction, fundus photography and visual field examination. However, it is imperative to understand that the optometrist retains clinical responsibility for the patient. (6) Moreover, the optometrist retains responsibility for the delegated task and for ensuring that it has been performed to the appropriate standard. (6) Therefore, it is essential that the person to whom the task is being delegated is adequately trained. Skills that make a good trainer or teacher have shown to correlate to good leadership skills. (11)

While, optical assistants require no official qualification to perform the aforementioned delegated functions, it is outlined in the GOC competencies that they must have appropriate knowledge and skills to perform the delegated activity. (6) Therefore, an adequate training programme should be put in place for the delegates to comprehensively acquire the knowledge and skills to perform these tasks. This should include training on how to use the instruments correctly, the purpose of the task, the recording of the results and how the results are communicated to the optometrist who retains clinical responsibility. In accordance with the GOC standards of practice, it should be noted on the patient medical record where parts of the eye examinations are being delegated to another member of staff. (6) Moreover, it should be noted what the results are, who conducted the task and when the optometrist, who holds clinical responsibility, has interpreted the results.

Depending on the delegated function, it may require a variety of skills and knowledge. Importantly, the delegated function may have varying legal requirements. For example, often the spectacle dispensing of children under 16 years of age is delegated to adequately trained dispensers who are not registered dispensing opticians. The optometrist in this situation, as with any other form of supervision, should comply with all legal requirements governing the activity. It is a legal requirement that the optometrist is on the premises during the supervision. It is essential to be on the premises, so that the registered practitioner is in a position to oversee the work undertaken and ready to intervene if necessary in order to protect patients. (6) This is particularly noteworthy where tasks such as the administration of drops or tonometry is delegated, which are relatively invasive procedures. As part of the GOC requirement, the optometrist should take all reasonable steps to prevent harm to patients arising from the actions of those being supervised. (6) This again emphasises the importance of thorough training and having the confidence in the member of staff to carry out the delegated task safely.

Management

Optometrists or managers already within leadership positions such as optometrist managers, practice directors or regional managers can still develop and enhance their leadership skills. By identifying their personality type or temperament, they can discover their strengths and weaknesses as a manager. (12) Therefore, it is important for managers to understand their own characteristics as this will enable them to undertake selfreview and take actions to improve. Consequently, they can become more effective managers alongside better leaders, strengthening their overall approach. (13)

For practitioners in a managerial role, overseeing staff can be complex. Essentially as a manager, you are managing people. (14) Whether it is during recruiting an employee or managing them, promoting equality and valuing diversity is an essential trait of a good manager. In fact, this can result in positive business performance, increased innovation and reduced staff turnover. (15) To be inclusive in all dealings whether it is with patients or colleagues without discriminating on grounds of gender, sexual orientation, age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief is very important as a registered professional. (6) It is equally important to understand each individual staff member's personality, strengths and weaknesses. There has been much research on different personalities and it is evident that certain types may clash. (16) Although managers may try their best to avoid personality clashes, it is inevitable that there may be disagreements between colleagues. Where disagreements occur between colleagues, it is of paramount importance to aim to resolve these. (6) Furthermore, the literature advises that optometrist managers should resolve barriers for employees to share knowledge to develop a more fluent performing practice. (13) Studies have shown that employees in the health sector are less satisfied with their pay but more satisfied with their sense of achievement. (17) Hence, managers should praise any success that employees may achieve. It is recommended that managers address work-related discomfort among employees to ensure they are content and healthy. (18) Optometrist managers are likely to become more recognised and respected leaders if these evidence-based recommendations are followed. Furthermore, it is the responsibility of the professional to ensure that a safe environment is provided to deliver care to their patients and take appropriate action if this is not the case. If patients are at risk because of inadequate premises, equipment, resources, employment policies or systems, put the matter right if that is possible and/or raise a concern. (6) Therefore, the manager must always ensure the systems that are in place in the practice are keeping patient and staff safety at high priority.

Leadership skills

Research has shown that a respectable leader will help a practice team to bond by unambiguously communicating objectives and explaining the rewards for meeting them, while implanting enthusiasm and calm any needless fears or emotions. (19) This is particularly important when a practice is inexperienced or in a stage of change. It is considered that leadership is a natural talent as well as a set of skills. Not everyone is born a leader. Nevertheless, leadership can always be improved by developing the necessary skills. There are many courses and workshops available that practitioners can undertake to enhance their leadership skills. (19) For example, the Association of Optometrists (AOP) holds a management and leadership workshop which is specifically designed to teach essential techniques and skills to become an effective manager and leader as an optometrist.

Key skills needed for successful supervision include being able to observe and give feedback, create effective action plans, perform reviews and effectively assess patient records. (7) These skills are particularly useful for pre-registration supervision but equally important for supervising optical assistants. Time should be made to observe and analyse the work, actions and record filling of the assistants. As a result of the reviews, effective action plans can be created to improve the outcomes. These action plans should be SMART--specific, measurable, achievable, realistic and timely. (20) Equally important to being a good leader is to praise and respect colleagues' skills and contributions while not discriminating. Whether its during supervision or management, a trait of a competent leader is to support colleagues and offer guidance where they have identified problems with their performance or health or they have sought your help, but always put the interests and safety of patients first. (6)

A leader and competent practitioner should be aware of how their own behaviour might influence colleagues and students and must demonstrate professionalism at all times. (6) A leader will act with honesty and integrity and ensure their conduct, whether or not connected to professional practice, does not damage public confidence in themselves or the wider profession. (6) This will earn respect by colleagues and patients and help to build leadership status.

It is evident that leadership can flow within the profession from the basic level of optometry students. (21) Studies have suggested that those who demonstrate good leadership attributes are self-confident, assertive, dependable individuals who value personal achievement and maintenance of the norms and values of the community. (21,22) Consequently, practising optometrists should seek to acquire and enhance these aforementioned attributes to earn the respect of colleagues and the profession. Furthermore, great leaders in optometry may be more active in community organisations leading to acquirement of leadership skills. (23) Therefore, an evidence-based recommendation for a practising optometrist looking to enhance their leadership skills would be to further their engagement in community organisations. This could include organisations such as the AOP and Local Optical Committees (LOCs). The professional competencies that practitioners should develop to enhance their leadership potential and management skills are summarised in Table 2. (19)

Perhaps the most important skill of a good leader is to communicate well; this is not only important for being an effective leader but also to be a good practitioner to build patient rapport as well as for managing staff. (24) One of the GOC competencies for practitioners is to communicate effectively with any other appropriate person involved in the care of the patient. (6) This includes any colleague you are supervising, managing or working with. Furthermore, the GOC standards of practice state that optometrists should ensure that the people you are responsible for are able to communicate effectively with patients and their carers, colleagues and others. (6) Therefore, it is important to relay guidance to colleagues in the team to ensure their communications skills are adequate. Communication is identified as either talking or listening. The four rudimentary styles of listening are: passive, selective, attentive and active. The four basic styles of speaking are: non-assertive, aggressive, passive-aggressive, and assertive. (19) Active listening and assertive speaking skills are important for optometrists.

In particular, optometrists should be competent with nonverbal elements such as proxemics to engage effectively with patients and colleagues. (19) It is advised that optometrists looking to become better leaders analyse their own communication skills and actively seek to improve these by attending appropriate courses.

It is evident that practitioners have the potential to become leaders in wider health care delivery. The literature suggests that optometrists should develop leadership and management skills as well as taking every opportunity to demonstrate their leadership to other professionals within health care delivery. (25) This could be in the form of acquiring leadership or management roles within the NHS or other health care governing or representative bodies. They should undertake additional qualifications and courses to develop their leadership and management skills such as those offered by many universities and corporate bodies. Optometrists must have faith in themselves that they deliver quality care and that they possess an abundance of skills to offer the healthcare system. (26)

Conclusion

This article has touched on some of the skills that are essential to be good leaders as optometrists. Leadership is a broad topic which covers many areas that are relevant for optometrists. Good leadership traits should be demonstrated during supervision and management. Perhaps the most important skill to demonstrate effective leadership is by having good communication skills. This will ensure a cohesive team working in the best interest of patients. Optometrists should be encouraged to further enhance their leadership skills by attending workshops, completing courses, reading literature surrounding the topic or simply by self-evaluating. This will ensure there is strong leadership potential within optometry to not only lead within the profession, but to become pioneers to lead in wider health care delivery.

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk. Please complete online by midnight on 8 June 2018. You will be unable to submit exams after this date. Please note that when taking an exam, the MCQs may require practitioners to apply additional knowledge that has not been covered in the related CET article.

CET points will be uploaded to the GOC within 10 working days. You will then need to log into your CET portfolio by clicking on 'MyGOC' on the GOC website (www.optical.org) to confirm your points.

References

Visit www.optometry.co.uk, and click on the 'Related CET article' title to view the article and accompanying 'references' in full.

Bhavik Parmar is a specialist refractive optometrist and is currently working through the Doctor of Optometry programme and the independent prescribing course. He has also completed an MSc in clinical health management and is currently the regional representative and councillor for the Association of Optometrists as well as being an Optical Confederation Joint Education Committee Member and sits on the DOCET Council.

Course code: C-59152 Deadline: 8 June 2018

Learning objectives

* Be able to communicate effectively to those involved in the care of the patient (Group 1.2.5)

* Understand the skills necessary to be an effective supervisor (Group 2.9.1)

* Be able to communicate and lead effectively within a multidisciplinary team (Group 9.1.1)
Table 1 Section of the GOC's Standards
of Practice relating to supervision

2.9.1 Be sufficiently qualified and experienced to
undertake the functions you are supervising

2.9.2 Only delegate to those who have appropriate
qualifications, knowledge or skills to perform the
delegated activity

2.9.3 Be on the premises, in a position to oversee the
work undertaken and ready to intervene if necessary
in order to protect patients

2.9.4 Retain clinical responsibility for the patient.
When delegating you retain responsibility for the
delegated task and for ensuring that it has been
performed to the appropriate standard

2.9.5 Take all reasonable steps to prevent harm to
patients arising from the actions of those being
supervised

2.9.6 Comply with all legal requirements governing
the activity

2.9.7 Ensure that details of those being supervised or
performing delegated activities are recorded on the
patient record

Table 2 Professional competencies for optometrists
suggested by West's research (19)

1 Identify strengths and weaknesses

2 Find the right mentors

3 Develop leadership skills

4 Cultivate communications skills

5 Innovate

6 Learn to make decisions

7 Learn to budget time

8 Learn to negotiate

9 Master risk management

10 Avoid complacency
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Article Details
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Author:Parmar, Bhavik
Publication:Optometry Today
Article Type:Report
Geographic Code:4EUUK
Date:May 1, 2018
Words:3001
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