Working Together: The Technician and Clinician Partnership

[caption id="attachment_247200" align="alignleft" width="300"] jozefmicic/stock.adobe.com[/caption] Michael Johnson, CPO, remembers when he started his O&P practice doing almost everything himself. From seeing clients by day to fabricating devices by night, the owner of OrthoPro, Idaho, worked long hours to build his business. Soon enough, he realized there was an easier way. With a trusted technician at his side, he saw that he could focus on seeing patients and building his business while the technician could concentrate on device fabrication. “Having someone I can trust who knows what they are doing makes it easier for me to provide more patient care, help the facility be more profitable, and help see more people,” he says. “And it ends those 16-hour days. When you are by yourself, you can work yourself to death pretty fast.” But clinicians working alongside O&P technicians to create the best possible device for the patient isn’t always as easy as it seems, the experts say. Through the years, the O&P profession has become more specialized, which means that technicians are trained in advanced fabrication techniques but not as much in patient care. Clinicians, conversely, may have a strong background in anatomy and human gait, but might not have a firm understanding of fabrication techniques. This lack of understanding of one another’s jobs can lead to a breakdown in communication and ultimately produce devices that might not be as optimal for the patient as they otherwise could have been. The experts say that to provide patients with well-fitting, high-quality devices, technicians and clinicians need to have a cooperative relationship built on respect, trust, and, most importantly, communication. “When it works best is when I expect you to be the best in your field and you can expect that of me,” says Justin York, CTP, manager of fabrication and clinical technologies at Mary Free Bed Rehabilitation Hospital, Michigan. Increased Reliance on Technicians Johnson doesn’t miss the days when he did the work of both clinician and technician. He says that model isn’t sustainable. “That model is old school. The easiest thing I have to compare it to is a dentist who might try to do the cleaning and the x-ray and cavity filling all by themselves,” Johnson says. “That model doesn’t work anymore.” Brad Mattear, LO, CPA, CFo, O&P central fabrication manager for Shriner’s Healthcare for Children, Florida and Oregon, has been in O&P for 20 years and has seen more and more clinicians cede the fabrication side of their business. The change has been a long time coming, he says. “There was a time in the industry when a lot of clinicians held onto the fabrication side because they didn’t have trust in outsourcing it,” says Mattear. “There was a nobody-can-make-it-better-than-me mentality.” Through the years, he says, O&P businesses realized they could add new patients, and grow their profits, if they let technicians do the fabrication either in the clinic or through a central fabrication facility. “There’s a business component,” he says. “Are you working in your business or are you working on your business? For those who wanted to grow, they needed to accept the change in fabrication so they could continue to work on their business and help it grow.” That shift to using central fabrication more hasn’t been seamless, he says. The work of the technicians he manages is limited by the quality of the fabrication instructions they receive. And, in the past, the instructions he received weren’t always great. He’s had instructions written on the back of a bar napkin telling him to “make it like you did the last time” and has seen devices mailed to a facility with no other instructions other than the word “replicate.” “It’s the old adage: poop in, poop out,” Mattear says. “The roadmap to success when utilizing central fabrication is communication. You have to be able to transpose what you have in your head onto a work order.” Even when the instructions are good, a small detail left off a work order can still stall fabrication, he says. “There’s not a day that goes by when I’m not talking to five or ten clinicians and it’s because we’re missing out on just a little detail on a work order,” he says. “We want to make sure that what you want is what you are going to get.” Getting that great communication takes both time and trust, the experts say. At Johnson’s clinic, they have a technician on staff and have a daily fabrication tracking meeting. This way the clinicians can share important information they have about the patients, and the technician can talk about the progress on the devices and anything that might be hindering that progress. “Every day we communicate first thing in the morning so the clinician knows when they will receive the device and the technician knows what kind of time frame they are under,” he says, adding that it’s also a good time to talk about any other issues that might keep the device from being delivered quickly. “With the advent of COVID, there have been supply chain issues to where we’ve had to travel a couple of hours out of the area even to get plaster. There have been different types of plastic that have just not been available, and we’ve had to talk about alternatives.” Good communication can come in different forms. At Mary Free Bed, technicians are often asked to meet the patients and see who they are making the devices for and see firsthand if there will be any complications. “We want them to be involved in fabricating a device but also see the ‘why’ behind it,” says York. They have shadowing opportunities for clinicians, or future clinicians, as well, he says. “Many residents won’t have a strong fabrication background, so they can shadow us in the lab to understand the limits and difficulties of our jobs and show them how they might word something on a work order.” A Division of Labor Changes in workflow and education have created a distinction in areas of expertise. While clinicians from another generation might have had fabrication experience, that isn’t necessarily the case with new graduates. And technicians who work in central fabrication facilities might not have a chance to interact with patients and see the devices they’ve built being fitted and put to use. This can lead to a breakdown in communication, the experts say. “We have these clinicians who might have a master of science in prosthetics and orthotics and are super smart,” Mattear says. “They have wonderful ideas and have been exposed to so much in school, but where they significantly lack is fabrication education because they don’t get that much exposure of that in school…. Conversely, because central fabrication is not connected to a clinic, the technicians don’t have the exposure of the fit. Understanding that part can close the loop for a technician. Otherwise, they don’t always see how what they are doing impacts the patient.” York says that having those two perspectives isn’t a bad thing, they just need to find the best way to use their combined skillsets to work together. “I break it into two parts,” he says. “Your clinician will be the expert at diagnosing the patients, understanding what difficult problems there are to solve, and will have a rough idea of what to accomplish. For the technician, the question is how do we build that device to accomplish those goals? We’re looking to get a clear understanding of what they want to do, and we’re the brains of how to bring that idea into fruition.” To get to that point, the clinician and technician need to have constant communication with one another and always be willing to reach out for clarification, the experts say. Mattear says that they’ve found that having a conversation with video—so the clinicians can see the device—has been a great help. “One of the good things that came out of the pandemic was video conferencing,” Mattear says. “Instead of just talking on the phone, we can hold up a device and say, ‘Hey, on your work order you are asking for this, but here are our thoughts, and this is what we are seeing.’” When things go wrong, it’s almost always because of a breakdown in the communication process, York says. “If a clinician asks for something on a work order and doesn’t take the time to talk one-on-one, something can be missed,” he says. “In their mind, they are writing it on a work order that conveys everything they want, but that’s not exactly what I might get from it.” He says that at Mary Free Bed, they try to err on the side of overcommunication. “We use phones, email, Webex, OPIE, you name it,” York says. “Our policy is that if you are in a gray area on the clinician or technician side, then just pick up the phone. It’s better to go into fabrication knowing what to accomplish than to guess it and waste everyone’s time.” Mutual Respect and Trust Kevin Soules, CO, an owner of Pediatric Orthotic Specialists, Michigan, says there is an open-door policy between technicians and clinicians. They can talk about any instructions they might not understand or offer suggestions if they think of perhaps a better way of accomplishing a task. “By working closely with our technicians, you get that trust in their craftsmanship, and you have multiple people putting their heads together to make sure we make the best orthosis possible,” he says. Cultivating this relationship took time, he says. Some previous staff at times didn’t embrace a technician-clinician partnership and treated it more as a hierarchy. “It made conversations like walking on eggshells all of the time,” he says. “We got to the point where we all put our egos in check and said, ultimately, that we’re all trying to reach the same goals and do our best for the patient.” Getting to that point of mutual respect ultimately benefits the business and the patient, Johnson says. “Sometimes clinicians look down on technicians and don’t appreciate or respect them like they should,” Johnson says. “If they don’t respect one another, then it will impact what you can provide for the patients.” One way to help foster this trust is to respect one another’s time, Mattear says. He tries not to interrupt or pull clinicians away from their work unless it is absolutely necessary. In return, he advises the clinicians to put their time and effort into providing clear instructions for the technicians. “We understand our clinician team members are extremely busy, and I don’t want to interrupt their patient care,” Matter says. “But if they are missing information on a work order, they are interrupting the process of fabrication. They need to take the time to make sure everything is correct, so they don’t do that.” Part of building that trust is listening to one another and handling conflict with respect. Mattear says he has received work orders that will not work with fabrication techniques or devices. Instead of just saying no or challenging the order, he says he comes into the conversations with possible solutions to solve the issues and still reach the same device goals. “You can’t ask for a round ball to go in a square hole,” Mattear says. “They don’t understand that they can’t have everything they ask for. This isn’t Burger King. You can’t have it all your way. But there are things we can do.” York says that sometimes there have to be compromises; for example, a device might not be as aesthetically pleasing as initially described, but it will work better for the patient. “It’s a give and take, but it all starts with a conversation,” he says. “Those exchanges between an experienced clinician and an experienced technician are so rewarding.” When those conversations happen, Johnson says part of his job is to respect the technician’s input. “If we need to modify a process, I have to be willing to listen to them and make changes.” If a mistake has been made by a technician, that too should be handled with respect, Soules says. “We need to make sure if something isn’t up to our standards that we give the technicians our construction feedback,” he says. “But we need to make sure it’s constructive. Not necessarily pointing fingers.” Johnson says that there will always be mistakes on both sides. “We expect mistakes to be made, but if they keep making the same mistakes over and over, then there will be a problem,” Johnson says. “Making mistakes is part of becoming better. It’s not whether you will make a mistake but what you do after you make it that matters.” If a person isn’t trying to learn from it, or if they think they have all of the answers, that signals a problem, he says. “The moment someone says they know it all, then you should run fast,” Johnson says. “We should all be learning and willing to learn.” Reaching Common Goals One of the best ways to foster a strong relationship between technicians and clinicians is to keep everyone focused on the same goal: helping patients. That means everyone needs to use their individual expertise, Soules says. When there’s an issue with a patient, the technician and clinician should be working together to solve it. “We frequently sit down and pick each other’s brains to figure out what we can do with these challenges and how to meet them,” Soules says. Their combined effort results in a better product for the patient and a better working environment in the clinic. “Everyone here is accountable to the goal of helping patients,” Soules says. “We work together to reach that goal together…. At the end of the day if we all believe in the work we are doing, it makes a better product.” Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com.

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