December 2011

How to “speak” central fab

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By Shalmali Pal

Outsourcing has become integral to streamlined manufacturing and, in the O&P world, central fabrication services fit the bill. Yet, for practitioners dealing with a customer service rep in a different time zone or an employee in a far-off land, communication isn’t always easy to achieve. Lower Extremity Review checked in with O&P experts on effective ways to communicate with central fab facilities.

Andrew Carroll, CO, of New England Orthotic and Prosthetic Systems in East Hartford, CT, said he had the central fab facility he works with set up a profile of his business, specifying his requirements and preferences.

“That profile states things like ‘ABC Orthotics prefers copper rivets to stainless steel screws.’ The technicians can always check the profile and see what my expec­tations are,” Carroll said.

Most facilities use fill-in-the-blank work order forms.

Mixing and matching forms from different central fab companies may seem like an easy shortcut—after all, they generally request the same information—but Jeff Quelet, CPO, owner and practitioner, Ability Pros­the­tics & Orthotics in Hagerstown, MD, says to avoid that temptation.

“One [work order] may ask for the patient’s height and weight at the top; another may list it at the bottom,” Quelet pointed out. “I’d rather that we take the time, every time, to fill out the work order properly based on what the [central] fabricator wants.”

Quelet and Charles W. Kuffel, CPO, FAAOP, president and clinical director of Arise Orthotics & Prosthetics in Blaine, MN, advise keeping molds, castings, and paperwork together. For instance, don’t put the mold on the last UPS truck for the day and then deal with the online order form the next morning.

“You would be better off waiting a day, and getting the mold and the work order out at the same time,” Quelet said. “It’s important to have continuity.”

Kuffel also endorses the benefits of continuity, and tries to work with the same individual in each interaction with his central fab company. The advantages are manifold: This establishes a one-on-one relationship and creates mutual agreement about which O&P terms to use as well as a paper trail for the device that can be traced to one person. Even if he is working with an “old friend” Kuffel always writes, “Call with questions” on the orthometry form and includes his business card with the mold.

When it comes to special or complex orders, which Quelet calls “the exception to the rule,” the level of communication needs to be stepped up. First, Quelet calls the fabricator to let him know that a special case is on its way. Next, he takes digital images of the anatomy and the existing device. Finally, he marks any special notations on the work order and on the mold itself.

Carroll, who owned a central fabrication outfit from 2003 to 2008, also puts a big, bold “Call before fabrication” on the work order, but he warned that “fifty percent of the time, I don’t get a call and the brace just shows up.” Often, the onus of follow up still falls on the practitioner.

The success of any conversation depends on two parties speaking the same language. All the experts LER spoke with recom­mended avoiding using jargon and, instead, being descriptive and specific.

“If I told a technician I’d like an Arizona boot, what does that mean? He may know the term but it offers no useful information,” Quelet said. “But if I say I’d like a leather triplanar ankle gauntlet to stabilize the calcaneus and talus, he can respond with, ‘Yes, I’m going to corrugate with 1/8 inch polypropylene material with a heel opening with scythed leather on the outside and cow hide on the inside with laces or Velcro for rigidity.’ Now we’re talking the same language.”

While O&P educational programs have made strides toward standardizing terminology, semantics change with the times. For instance, Kuffel may ask for a Sabolich modification and the person at central fab may only know that as a varus control tab.
“As the profession has evolved, many older terms and techniques are no longer recognizable,” he said. “Generational differences exist.”

Sponsored by an educational grant from Lower Limb, A division of Spinal Technology

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