Getting the Most Out of Your Fabrication Team
March 2020 Issue
Having been a technician, lab manager, and central fabrication lab owner for more than thirty years, I've had the opportunity to work with some great clinicians and customers. They've taught me a lot about how to make the job of maximizing the efficiency of a fabrication team possible, and a lot about how to slow the process down. So I'm going to point out some simple actions you can take with your team to help make the process as smooth as possible. The list isn't comprehensive but includes a few basic rules to get the most out of working with your fabrication team.
First things first: Your orthometry forms need to be complete and accurate. I get it; you're busy and have a lot of paperwork to do. But this is the most important piece of paper you have on your desk. You take your time meeting with the patient and designing an appropriate device, and you need to have that care and attention translated into a product. My best advice is to use as few pieces of paper and be as concise as possible in your verbiage. Don't repeat information; it just confuses people and causes mistakes. Think of your orthometry forms like the tickets used in a restaurant kitchen. Only include information that is critical to the job, and use the check boxes on the form. If there is a check box for Tamarack joints, you don't need to also write in Tamarack joints. Also, be sure to write measurements on the form. It was once standard practice to provide measurements on orthometry forms, but people have become so reliant on their casts that they rarely provide them. The problem is that casts can be damaged in transit, or even just be bad casts. I often say, "I don't need measurements to make an orthosis, but you need to provide measurements to make sure I did it properly." Communicate your desire clearly, and you will be laying the groundwork for a positive outcome.
If you want a great orthosis, your cast needs to be great. The technical staff rarely sees the patient, so we have no idea if the cast is an accurate representation. If you take a poor cast, the odds of the technician fixing it is pretty slim. If the dorsiflexion angle is off or the cast needs corrected in the frontal plane, make sure to note it on the orthometry form. We can usually correct it, but if its badly roped, or the forefoot is inverted 45 degrees, it might be worth a recast. I realize taking an accurate cast can sometimes be a challenge, but it is the primary requirement of a good device. So if you take the cast off and it doesn't seem right, take another one. Patients will generally be a lot more willing to put up with redoing a cast than they will with time-consuming adjustments and an ill-fitting device. Your job is to take a perfect cast, and my job is to not screw it up.
Nomenclature is important. Just like dialect is regional, so is nomenclature. We all have different in-house words to describe different things, but most of the time the people outside of your office don't use those words. Sabolich trim lines have about five different names depending on the region you are from (three-point prong, pressure pad, out flare, varus/valgus prong, varus/valgus trim, etc.), but most people seem to also know them by that name. When you fill out an orthometry form, try to use universal nomenclature to ensure the order is clear. As much as I love talking to clients, it is time consuming for the technician and the clinician if we have to call to get clarification on an odd term.
Designs need to be simple and easy to produce. Twenty years ago we made things differently, we had different materials, and different tools, and a lot of things have changed. Because some older designs and materials have been superseded, if you have been specifying the same design or material for many years, be prepared to discuss alternatives with the technician. He or she may be able to suggest something that has taken the place of an older method.
One of the things I have always wondered about is how clinicians decide what to send to central fab. Most seem to send out weird, complex devices and keep the easy jobs in-house. However, this seems counterintuitive to me because the complicated devices are the ones clinicians most need to observe during fabrication. For example, most clinics will have prescriptions for ten AFOs for every KAFO, but will send the KAFO out for fabrication and make the AFOs in-house. While this may seem efficient, the reality is that if the device is going to be difficult for you to fabricate because the patient is very particular or there are intricate adjustments that need to be made, it may be more advantageous to keep that one in-house and send out the easier jobs.
A picture is worth a thousand words, literally. Almost everyone has a cell phone in their pocket, so if you have a challenging case and are finding it hard to describe what you want, snap a few pictures and pass them along to the fabrication team. Just remember to include something to give an idea of scale, and make sure the photos are in focus. Having a few photos, especially of devices you want to duplicate, will go a long way in describing the problem.
Whether you use in-house fabrication or central fabrication, it makes sense to make the process as efficient and effective as possible. As a rule, people tend to envision their end product with certain clarity, but the rest of the team might not share that vision. The best way around this is communication. The better you can share your vision with the rest of the team, the better your outcomes will be.
Anthony Wickman, CTPO, is the CEO of Freedom Fabrication, Havana, Florida. He can be contacted at email@example.com.