Creating and maintaining clear, transparent policies is central to building accountability and trust within ophthalmic practices, according to a session presented at the 2025 American Academy of Ophthalmology (AAO) Annual Meeting. In a course titled “Creating a Culture of Accountability: Policy Development for Administrators,” presenters Brittney Wachter, MBA, CPC, COE, OCS, and Jessica Schroeder, MPH, CPC, OCSR, discussed how well-designed policies define expectations, promote autonomy among practice leaders, and ensure consistency within practices. 

"We're with you," said Ms. Schroeder in response to an audience poll in which many audience members indicated they "definitely need some work" with regard to a solid foundation of policies in their practices. "We're in this phase of growth, and with growth comes the need for more policy," she said.

The presenters outlined distinctions between policies contained in an employee handbook and those issued as standalone documents. The employee handbook, they explained, should serve as a broad, single reference that encompasses culture, values, expectations, and compliance with federal and state laws, and applies to most workplace rules and benefits. Standalone policies, by contrast, address specific operational or technical areas such as HIPAA compliance, IT security, or surgery cancellation procedures—topics that may require frequent updates or role-specific training.

Best practices, they described, include reviewing both the handbook and standalone policies annually to determine whether updates or consolidations are needed. Significant policy changes should be redistributed to staff with written acknowledgment after review by HR and legal counsel. Ms. Schroeder added that it's also possible to review new handbook policies as standalones if they're not going directly into the handbook during the annual review.  "You can use that as a temporary measure," she said. The presenters discussed the importance of creating policies that include clear expectations, accountability, and autonomy for practice leaders.  To accomplish that, they provided a model process for policy creation and implementation:

1. Define a clear objective and rationale for the policy.

2. Write concisely and directly and explore “if/then” outcomes.

3. Involve key stakeholders, including administrators and managing partners.

4. Secure formal approval and communicate changes in a staff meeting before requiring employee sign-off.

They used a sample time-off policy—which included information about the aim of the policy and why it was created, detailed descriptions about policy elements, steps that need to be completed by staff or management, and approvals—to illustrate how to clarify expectations. Accountability, the speakers said, depends on supervisors enforcing policies consistently. Incidents should be properly documented, and deviations from written policies should be avoided to maintain fairness and transparency. This is where if/then plans come in handy, they noted. "It's much easier to approach an employee who's breaking a policy if it's written in black and white," Ms. Schroeder said.  Ms. Wachter added that this is easier for the doctors as well, regardless of how well an employee is doing. Engaging physicians early in the policy creation process is essential to aligning administrative and clinical leadership, they explained, and setting shared expectations between administrators and doctors not only fosters autonomy for practice managers, but also helps ensure policies are upheld throughout the organization.

Attendees contributed questions regarding the strictness of late policies and how to manage not only their staff but also their physicians who may be consistently late, even by.a minute or two. "It's about the patient experience," said the presenters. "If patients are there and we're not, that's a problem." The focus, they added, is on when someone is late often in a short period of time. They noted that the audience discussion illustrated the emotional pitfalls in policy decision-making and enforcement, and reinforced the importance of having clear policies to be able to remove the emotional element in dealing with policy violations.

To reinforce expectations, the presenters recommended selecting one key policy each month for review during staff meetings, and attendees were encouraged to consider how they reinforce policies and expectations in their practices. Examples of which policies to review included uniform, service and support animal, cell phone, recall, and comanagement policies, among others. 

"Communication is key," they said, even if it's not a written sit-down. In addition to the monthly reviews, policy violations should be addressed "in the moment" so the issue doesn't linger. 

Ms. Schroeder added that it's possible to move someone to a new role or department if they're otherwise a great employee, but aren't able to meet a policy requirement because a life circumstance has changed. She described her open-door policy and how collaboration with addressing a problem can be a way to accommodate people you want to keep.

"The cool manager follows the policies and holds people accountable," Ms. Wachter said.