Building a relationship with labs
Bill Keller, CDT
Ask a lab technician how many times a dentist has asked, "What impression material do you want me to use?" That`s right, dentists really do ask technicians about making impressions, even though technicians do not take impressions. This, to me, was a perplexing juxtaposition of a relationship when I first began my career in the laboratory. Why were these highly trained professionals asking me about what they should use doing their job? I quickly realized why this was the case and I`ll come back to that conclusion in just a moment. One thing was certain, though, the relationship between technician and dentist is a very special one within the health-service delivery system.
Most dentists, today, operate in a very independent fashion and their daily professional contact frequently is limited to that of internal team members. There really aren`t many practitioners who have peers or mentors regularly reviewing activities and production. Practitioners can be pretty demanding of themselves - perhaps sometimes more so than is reasonable - but it`s still not exactly Dr. Peter Dawson or Dr. Gordon Christensen looking over their shoulders offering suggestions and encouragement. So, for dentists working in an isolated small business environment, what then can be a powerful tool to provide continuous improvement in the quest for practice-efficient, high-quality dentistry? What can provide a window to a vastly larger perspective on what is done every day in the office?
I concluded that one of the reasons my clients were asking me about impression materials had to do with the fact that I was in a position to witness what materials their colleagues were using and I was dealing with many dentists. The real question was "What are other dentists using and which materials are delivering the best results?" Obviously, the query had nothing to do with my ability to use an impression material properly. Communication with the laboratory is one of the ways dentists can obtain a perspective on what`s going on in dentistry.
A number of windows can be used to shed light on the kind of practice you aspire to develop and maintain. Continuing-education courses, purposeful contact with colleagues, dental-supply reps, and dental laboratories provide just such windows to a wider view of dentistry. Observations of some of the most progressive and satisfying practices reveal almost an exploitation of at least one or more of these windows. It seems as if these special practices are able to gain exponentially from accessing other people`s experiences as well as their own.
Typically, being used or exploited would create a very negative connotation, but there may be a way, in the case of the dental laboratory, to exploit the relationship while leaving the lab crying for more of the kind of "using" you are applying. Now, if you could use your laboratory to improve your own abilities, while generating an enthusiasm within the lab about working with you, would you want to do it? Then, stay with me. Let`s throw one window wide open. I`ll offer some coaching and ask some questions, but I`ll need your help. You`re the only one who can do it and all the credit for accomplishment will belong to you. Now, we`ll explore three areas in greater detail: 1) the general interview, 2) case-tracking, and 3) attending CE programs together.
Interview the lab by opening a general dialogue aimed at discovering characteristics, products, and materials linked to top performance. The goal here is improvement, not perfection. Here are some questions to help kick off the conversation:
(1) Would you tell me about the products most widely requested by other dentists? This question begins the interview process on a level that the lab personnel are most comfortable with - technical questions about what they do. It displays an interest in them and creates an environment for the interview that is most inviting. The question also gives you a chance to learn about materials and techniques that may serve you well later. It serves to validate your laboratory selection and initiate a relationship-building process where you feel comfortable enough to inquire about products and materials unfamiliar to you. It also serves to answer that typical question about what the other guy is doing, without asking it in the same worn-out manner. You get answers and information, while looking very good doing it.
(2) What kind of restorations do you consider to be of the highest quality and what remake experience have you had with these products? This question delves deeper into what the lab really wants to be doing, but it does put the lab on the spot a little with the reference to remakes. You learn more about materials and techniques, though, and begin to develop a more serious communication level.
(3) What is it you really like about our office? This question is preparatory to opening the door to positive communication. The desired result in this process is quality improvement. The question is just a means of getting the lab to speak with you in a spirit of enthusiasm and confidence. This is the icebreaker for more serious dialog.
(4) If you could change one thing we do in our office, what would that be? How would you have us change? We`re really starting to get somewhere with this question. You get a sense that the lab personnel are opening up to you in a way you may have not experienced before. This question becomes extremely powerful. Imagine how you would feel if you were on the receiving end of a question like this. The question is empowering to the receiver. The result for the questioner might be that one simple change could make a significant improvement in the work ultimately delivered. Now, the lab is ready to work harder for you than you could ever imagine. You are building another aspect of the team that will bring you great gains.
(5) Call to mind five top-quality customers, dentists with whom you love to work. What is it that makes you think so highly of them? Now, you`re really getting into the heart of the matter. You are going to gain access to other people`s experiences and have a chance to make them yours. Be specific here; you`re looking for clinical guides, personality traits, working conditions, and the like. Ask if the top practices select high-end restorations and end up with very low remake experiences. Remakes are extraordinarily expensive and will force up the cost of the restoration. Low remakes bring the cost down; hence, the strong relationship between high quality work and low remakes. The cost of the crown may not be what you think it is. Do these top performers tend to do two crowns or perhaps a quadrant at a time, as opposed to a single tooth that needs a crown the most right now? Technicians frequently wonder why one crown was done when just adding the tooth right next to it would enhance the case. What about gingival-tissue management? Could an analysis of gingival-tissue height - and possibly recontouring to equalize the height - have significantly improved the esthetic result? The objective here is to identify qualities and characteristics of highly respected practices. You`re looking to emulate the best by applying the lab`s broad experience with many clients.
(6) Where would you rate our office in each of these characteristics? This question, of course, requires distillation of the previous answer into some specific categories. Spend a little time separating the clinical and personality traits. Open up here; make certain the lab has your permission to give you honest feedback. It is important for the exchange be kept positive. It is quite possible to give an honest analysis and focus on what actions can be applied to improve quality vs. harping on the weaknesses.
By this time, you have accumulated a tremendous amount of information. This can form the basis for an action plan to really catapult your practice in the direction you want to go. You`ve built a powerful relationship with your laboratory. You can really exploit the lab, with the lab loving every minute of it! The more adept the interview, the greater the opportunity to access information. Plan to repeat this interview process periodically, because treasures will continue to be uncovered over an extended time. Continued discovery will lead to progress. Continual progress will bring greater satisfaction and greater profitability.
Laboratories have used quality-control response cards with varying success, and you probably have your own opinion of this approach. I want to relate an experience we had in our lab with a reversal on the quality-control comment request.
We received a QC comment on a case sent to us. The dentist sent a card with the case, asking for the technician`s evaluation of his work. The checklist requested comment on his tooth preparation and impression, including interarch clearance, visibility of margin, adequacy of facial reduction, specificity of Rx, etc. We were incredibly impressed. Never before had a dentist so candidly asked us to give a written evaluation of his work. That was our first reaction. Then, a completely different feeling set in. If we gave a glowing approval to something that was not adequate for the type of restoration requested, and the end result fell short of the dentist`s expectations, then we were in trouble. In other words, if we said there was adequate clearance and the shade and anatomical form in our final restoration turned out to be lacking, it was our fault. If we said the margins were absolutely clear and then missed the finish lines, it was our baby. We became terrified. In short, we would be on the hook for the ultimate result if we glossed over initial shortcomings. We would be eliminating any excuses for the final result.
Finally, it became clear that the intention was to improve the opportunity for success, find someone to blame. The dentist wanted to provide the lab with what the lab considered to be important to deliver the best possible restoration. I believe that to be true of many practices, but they may lack adequate communication with the lab. Establishing a system to track the entire process of each individual case, from pre-op to post-op, can open a free exchange of constructive requests and feedback for every case. Then, compiling data from a series of cases will allow charting trends on what actions to take. The result will be better restorations with fewer complications.
The goal, then, of any case-quality tracking system simply becomes creating history by which trends can be charted and objectives can be set. A good system entails comments on both sides of the case, outgoing and incoming. The control card tracks specific elements from the prep side, as well as the lab final-restoration side. What components should be included in this tracking? Let`s take a clue here from the areas that drive you crazy. If occlusal adjustment is most frustrating, then make certain the tracking includes areas specific to that, like amount of reduction. The documentation for the case being sent to the lab contains the criteria defining a successful case. The return critique card rates how well the case was accomplished.
Pick a period of time and ask the lab to QC your cases on specific items while you do the same on the returned restorations. At the close of the time period, compile the data, chart the result, and then review together what actions will be appropriate to bring about improvement. In this way, specific cases can be turned into general observations and given priority as well as action plans. Not only will the discussion open the door for case improvement, it may lead to a look at materials and techniques that are providing consistent results. Again, other fine clinicians` experiences become yours vicariously through the laboratory.
Attending CE programs has been shown to be an effective way to build practice skills. Statistics indicate that there is a link to CE hours and practice success. Higher- producing practices spend more time in CE. Certainly, approaching CE with a definite plan would serve to enhance the outcome. First, determine what areas of the practice you are most interested in developing further, and then research what is available to advance your cause. Ask dentists that you admire, mentors, supply reps, and your lab people for recommendations on courses and clinicians.
Once you`ve assembled a list of clinicians and courses that you believe will be valuable, categorize and prioritize them. CE can be an expensive proposition, but one that can provide substantial returns. The key is to maximize your investment with thoughtful, purposeful planning. Attend a course with someone. I`ll further suggest going with someone from your laboratory. The perspective from the lab side can give special insight into the viability of new products and techniques.
On the other hand, while you are attending the course with someone you know, make sure you reach out to meet other attendees. These are relationships waiting to happen between people of like minds. Again, you`ll get a lot more bang for your dollar if you build relationships with others who are seeking what you are seeking. Just where do you think those people are? They`re sitting right there in the same course you are attending!
Adding profits to your practice - your business - is key to being able to pay the best wages and purchase the best in equipment and materials to deliver the finest care possible. If you can`t have a notable mentor there to help guide you along the way, why not use other ways to increase profits? There are windows that can provide additional insight to your world - CE courses, other dentists, mentors, dental-supply reps, and dental laboratories. Go ahead and use these people to gain experiences. When they help you, it`ll make them feel good.
Exploit your dental-lab relationship. Use the lab to profit more greatly. I contend that the lab will embrace being exploited in this manner. I, for one, am one lab guy who would love to be exploited like this. Everyone stands to profit in this equation - the practice, the lab, and the patients. In fact, maybe the patients profit the most here as the ones who gain the most.