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Adopting a continual improvement process is a never-ending challenge. There are areas of opportunity in any process and inefficiencies that need optimization or elimination. Dental labs are built upon the production process, so inefficiencies can be a margin killer, particularly in a price-competitive industry. We look at how you can identify and address weak links in your lab, from remakes to margins to leadership, that negatively affect your efficiencies—and what you can do about it.
Investigate Your Remakes Causes
Tim Torbenson, President of evo820, LLC, says a common weak link for dental labs is remaking a case without investigating why it is necessary. If a lab never explores the cause, there is no opportunity to correct the problem.
"Throughout our profession, free remakes are extremely costly," Torbenson says. "The true cost is not only the remake of a single case, but it is the loss of time that should have been spent on the process of a new and different case. That is lost revenue twice and a domino effect that continues to build lost revenue and production time. The profits from the next several cases will be used to compensate for the profit loss from that one remake."
Torbenson says labs must understand the source of the remake problem. Also, to fix the situation in the future, the lab should begin documenting remakes to see where the problems exist.
Torbenson cautions labs against overcomplicating the remake recording process and suggests adopting a simple to maintain but adequate record instead. His company's eQMS, an electronic quality management system (QMS), has a complaints module to manage remake documentation, which is stored digitally.
"When you identify the cause and understand the pathway to correct, then you can start taking action to minimize your remakes," Torbenson says.
When documenting the remakes, Torbenson says the lab should categorize their remake sources, Internal or External. Then, the lab can identify the originator of the remake and gather information leading to a solution. An added benefit here is that the remake and the process to fix it have documentation that is FDA-compliant and stored online. Plus, recording the details surrounding the remake can help identify opportunities in a lab's process, Torbenson explains.
"Internal remake causes occur in your manufacturing process, and once you know that you can begin to track down if it is an issue with software, material, equipment, personnel training, or miscommunication," Torbenson says.
Travis Zick, co-founder and Director of Finance & Acquisitions for Apex Dental Laboratory Group and former President of the National Association of Dental Laboratories (NADL), agrees that remakes, and in particular, internal remakes are a weak link in the industry.
"Most labs, probably 90 percent, have a good idea of their External remake factor, but I find that many labs have no idea what is being redone within the building. So, on the production side, that's a huge weak link," Zick says.
Internal remakes have a lot of causes. It could be mechanical, like when the mill breaks down in the middle of a run, or the sintering oven doesn't complete a cycle. More often, though, Zick says its cases kicked back in the quality control process (QC).
Most labs have a QC, but it is often at the end of the line, which is late in the process for a remake. Zick recommends having continuous QC throughout the process. QC should oversee the cases when they come in, after design, and at each step to identify if the Internal remake is a one-off or the result of a process problem.
"You want continuous QC because once it's at the end of the line, it's too late. Just think of all the time, materials, and labor wasted at the point, especially if the problem was a design issue," Zick explains. "You could have caught that before you ever went into production and saved yourself a lot of money."
Regarding External remakes, Torbenson recommends the lab initiate the process to track and grade clients on their remakes. It can help a lab determine if the client is a benefit or a liability.
"This process will lead to a better understanding of an account's value to your lab," Torbenson says. "A lab where I worked did an annual client evaluation based on their remake rating, and many were asked to find another lab."
Challenge Your Basic Processes
Greg Martin, National Director of Sales for Renfert USA, says labs take what may seem like a fundamental process for granted. However, he explains that just because they have been done a certain way for a long time doesn't mean they can't be streamlined or made more efficient. Whether it's trimming models more quickly and efficiently, having denser, more accurate, and consistent models (controlled expansion, etc.) to provide more accurate fits and lowering remakes, or saving time and abrasives by having more efficient and focused sandblasting, Martin says there are steps to take that can make a difference.
"Time is money. More efficient processes are one way to sure up any weak links. Keeping your steps consistent allows you to develop reliable systems that will increase profitability," Martin says.
To fix it, Martin recommends looking at all your steps and eliminating unnecessary workflow bottlenecks. He says that reliable and dependable equipment can also save a ton of downtime. However, having good equipment also means you should do regular maintenance and upkeep.
"Making this a part of your lab processes will keep your equipment running smoothly, make it last longer, and save you money in both the short and long term," Martin explains.
Moving forward, labs should ensure they have periodic reviews of workflows. Martin says documenting the processes and records to create measurable data points is also essential so the lab can use this data to pinpoint your weak links.
"The more systematic your workflows become, the more easily you can detect any anomalies in the process and pinpoint where things may have gone wrong and where you can improve," Martin says.
Develop Your Leaders
Conrad Rensburg, ND, NHD in Tech, owner of Absolute Dental Services, believes in continual improvement, particularly leadership. A lab's leadership sets the company culture, so Rensburg prioritizes leadership development in his organization. In particular, he wants his leadership team to inspire lab workers to believe they are part of something special, more significant than themselves. Plus, he wants leadership to ensure the team feels heard, cared for, and respected.
"Leadership to me in a company is extremely important," Rensburg says.
However, the lab industry has an inherent problem with leadership in that many of the managers were or are technicians. Sometimes technicians are great leaders, but sometimes they are not, at least not naturally, he says. To combat that, Rensburg and the team will read a leadership book together and discuss how to implement it in their business model. In addition, they engage in an annual leadership meeting over a weekend.
"It's hard to drive a good quality business if you don't have quality leadership," Rensburg says. "Putting the wrong manager in the wrong position can be disastrous for your company."
Know the Details about Your Team's Productivity
Zick evaluates labs a lot. He sees a few everyday things labs do that they do not realize are weak links. For example, regarding production, many labs do not know the productivity levels of their technicians. Managing production key performance indicators (KPIs) ensures that the lab output aligns with its goals.
Zick says all of today's lab software systems can provide productivity metrics for individual technicians. Most labs need to use the feature. He says that a small lab could probably track it by hand if they didn't have a lab management software system. Knowing how much each technician does per day and what the lab is billing on their behalf is essential to managing productivity.
Having benchmarks and goals in place is another critical part of this effort. Also, getting the technicians to use the system is essential so they will scan the case as it moves through the production process.
However, this clarity raises another issue for labs.
"Especially in today's tight labor market, labs are reluctant to pull the plug on an employee that's causing problems in the building because they don't know where they will find a replacement," Zick says.
Zick understands the sentiment but suggests that eliminating that weak link makes the lab more productive.
Involving the team in the vision of the lab is essential, too. One thing Zick and his management team did this year was to clearly define who the Apex Dental Laboratory Group was as a company and what the critical metrics were. Most importantly, Zick says this message included where the team fits into the company's goal. Zick says this clear communication goes a long way toward eliminating some of those weak links.
"If you provide clarity to your team members on who you are and what you're all about and where they fit into it, you're much more likely to get buy-in," Zick says. "Certainly, you're much more likely to have an ongoing culture where new people coming in will quickly be on board or weed themselves out. As a result, you are in a much better position for long-term success."
Getting Ready for Changing FDA Requirements
Mark Palmer, General Manager of Zahn Dental, a division of Henry Schein® that specializes in providing lab solutions, says that many labs could be more prepared for the validated workflow requirement required by the Food and Drug Administration (FDA). Palmer thinks there is much confusion surrounding these new federal regulations, and that labs are looking for solutions to help manage these regulations.
Torbenson says the new requirements are for labs that manufacture or distribute titanium (TI) bases and blanks. Labs that support implant cases with Ti bases or are milling Ti blanks for custom abutments fall under the FDA’s umbrella of oversight and need to comply with their requirements. Among other things, one of the requirements is to have a QMS in place.
Also, the FDA dental branch has been training dental inspectors on how to audit dental companies and dental laboratories since 2020. This change indicates that the FDA is getting more serious about enforcing compliance, Torbenson says.
“Now, when an inspector walks in your dental laboratory, they know exactly where to go and what to look for,” Torbenson says. “In the past, we used to have to train a dental inspector what a dental laboratory does because they had no clue. For the first 2 days, we told them what we do, and then they audited on the third day.”
Torbenson’s evo820 is one of Zahn Dental’s latest solution companies that Zahn will be showcasing at LMT Lab Day 2023 and offering to dental labs in 2023. Palmer, who has worked with Torbenson for 20 years or more, likes the fact that the FDA quality system requirements that the evo820 eQMS offers are digital, rather than physical. The software solution replaces the bulky binders that contained the QMS on cases that came through and hold documentation of any complaints and how it was resolved. Palmer sees implementing the eQMS as an excellent way to eliminate the weakness regarding the changing FDA requirements.
“Our goal is not as much to be a distributor of a product,” Palmer explains. “We want to bring the lab a solution, not just put something into the laboratory and let them figure it out.”
Develop Employees Skills
Rensburg believes in continual technical training and encourages members to cross-train in different areas of the workflow. As a result, Rensburg schedules specialized training for their technicians every 4 to 6 weeks. The cross-training sessions aren't necessarily to move team members to different departments, although that could be an option over time. Instead, the training helps the team understand the company's comprehensive operations and vision.
"It gives people a little more buy-in than just working at their little bench and not knowing what goes on in the bigger company," Rensburg says. "It's all about keeping people engaged and ensuring they understand they are valuable to us."
Zahn Dental also has an education and training department (Zahn Academy™) that can help in this effort.In 2022, they had roadshows all across the US. The Zahn Academy team brought the technology with them and walked attendees through different workflows, like digital dentures, implant-supported prosthetics, 3D printing, and more. Coming out of the pandemic, these roadshows were successful events, Palmer says.
“We were all so glad to see each other, attendance was off the chart,” Palmer says, adding that Zahn will continue the roadshows in 2023. “Not only were we able to see people, but we were out there demonstrating the solution and making it easy for them not to have to take off too much work.”
In addition to 11 scheduled roadshows in 2023, the Zahn team is also re-opening a technology center in Wakefield, Massachusetts, in the Boston metropolitan area. It is set up with all the 3D printers and other digital workflow technology. In-person training begins there again in 2023.
“The roadshows are what the owners and managers want to go to, to see the solution in person,” Palmer says. “But if they want to convert somebody over from an analog technician to a digital technician, they will send them to the Wakefield facility for a scan to final product training.”
In addition, Zahn Dental is changing its approach to the 2023 Chicago Midwinter Meeting tradeshow. Instead of having individual booths of different products, Zahn is using a workflow approach for attendees. Each workflow presented on the showroom floor will have a step-by-step, color-coded solution mapped out using the products the Zahn team has already tested and optimized for their clients.
“We want to take you down a solution, a path, for whatever you are looking to do,” Palmer says. “You get so many people trying to tell you so many things. We want to determine what product a lab wants to deliver to the doctor and take that lab down a solution path we tested and came up with the efficiencies ourselves.”
Get a Handle on Your Financials
Zick thinks financial oversight is a weak link in the industry. Managing the business and the financial performance is a lower priority than getting the work done. Zick—who lectures for the NADL on financials, KPIs, and benchmarking a lot—says financial management is a regular opportunity he encounters.
"Most lab owners and managers were brought up as dental technicians. So, they're busy doing the work," Zick explains. "For them, it's always been, 'if we do a good job and put out a quality product and we take care of our accounts, we're going to be financially successful.' But, unfortunately, that's not always the case in today's lab world."
Zick says that having a better understanding and managing the financial aspect of their business, such as knowing costs, is essential. For example, many labs charge what they do to be competitive but have no idea what it costs to make that product.
Zick encourages labs to set the price based on costs, not what the competition charges. However, you should also be able to articulate the value you bring to the equation. Then, you can explain why your price might be higher than the competition.
"Whether that's additional service or improved quality, you have to be able to justify it with specific things you do," Zick says.
With production systems and KPIs, Zick says it requires constant monitoring of those KPIs regarding employee satisfaction, margins, remakes, and customer retention. Most of the software systems have auto-generated reports that have settings for how often a lab wants to see them, Zick explains.
"That's one of the nice things with the tools we have at our fingertips today with technology," Zick says. "It doesn't mean manually searching for this information. Instead, it's right at your fingertips."
Feeling Reluctant to Outsource
Palmer recognizes that labs are having a hard time finding employees, especially on the digital side. Plus, to find a lab technician with the artistic hands and the digital skills is like trying to find a pink unicorn.
Palmer says that Zahn has responded by developing an outsource solution that can help the lab with design services. Palmer says that way the lab can still produce the product, and even still design some of the products, but will have a resource that can help with digital design when they need it.
“Zahn is providing design services directly to the laboratory. That way they can facilitate a lot of these processes, especially digital dentures, and other fixed and removable prosthetics,” Palmer explains.
Build Team Engagement
Team engagement is essential to a lab. People need to feel important and appreciated as an individual, Rensburg says. At first, he had difficulty understanding some people had different values, including having an organized workday with predictable end and start times. In addition, not everyone wants to build a company, which was hard for him to comprehend.
"They want to come to the office in the morning, and they want to go home at night, and that's what they'll give you," Rensburg says. "Sometimes we have to realize trying to change somebody from something they are to something you wish they would be is the biggest mistake we see in our business over the last 20 years."
Along those same lines, Rensburg believes you should also cut your losses with some people. The quicker you let someone go who isn't a great fit, the better it is for that person and your business.
"Making quick, strong, and sometimes difficult decisions has to be done," Rensburg says. "I've always said there's only 2 types of Absolute employees, current and past. The current ones love me. The past ones, not so much."
Zick feels like the team drives the reality of the culture at the lab with their buy-in and participation. Therefore, developing relationships with the team is essential. The adage goes, "Nobody cares what you know until they know you care." In today's world, Zick says creating this atmosphere of personal relationships in the business is crucial.
Also, management should create an environment where team members feel appreciated rather than one where they punch a clock and get a paycheck.
"Don't get me wrong; we all have some people on our teams that want to do that," Zick says. "But we have found a lot more people want to be a part of it and feel like they have a stake in what's happening on a day-to-day basis at our company."
Remember, It's Never Done
Eliminating weak links is something you never finish, but you can outsource. Palmer says Zahn has its eye on what’s coming tomorrow. Labs should allow themselves to delegate some of the trial and error it takes to develop a workflow, too.
Zahn’s research and development (R&D) department tests the manufacturers’ products and crafts a workflow that maximizes efficiencies with the combination of products from their partners. Zahn’s R&D also provide feedback to manufacturers to ensure the product is easy to use and produces reliable results. Palmer thinks labs should leverage Zahn’s efforts and save themselves the trouble.
“Let us and our R&D, our support, our technology and merchandising take care of that for you,” Palmer says, adding that he didn’t have that resource when he was an entrepreneur himself. “Instead of just providing products, we want to provide product A plus product B, plus C is going to be your most effective and efficient way to do things.”
Another essential component to eliminating weak links is constant vigilance. These are the opportunities today. However, after addressing these, another area will need attention. It's the nature of continuous improvement, Zick says, and embracing this reality is vital.
"We talk about continuous improvement processes, which means you're never done. You're always trying to improve, to find more efficient ways or better ways to build a mousetrap," Zick says. "You can never sit back and say, 'Okay, great, we're done.'"