Reaching the Breaking Point

"It's a good feeling, hearing that," Polansky says. But this evolution didn't happen overnight. "I sat down with several of my dentists who were difficult to work with and told them what I needed. Over the next year or so, this dentist in particular really flourished into an amazing practitioner," he says.

For some, the very thought of working with difficult clients can make the blood run cold. These customers may be overanalyzing every case the laboratory delivers, demanding too much of the laboratory's time, ignoring those countless invoices, behaving rudely, or having unrealistic expectations. They may even be challenging to manage. Like the rest of the business world, the dental laboratory industry has its fair share of tough customers.

"You can't escape it. It doesn't matter what level of technician you are or the business you operate," says Polansky, owner of Niche Dental Laboratory, a high-end, two-person facility in Cherry Hill, New Jersey. "We are in a service business and that means some customers are going to be tough to handle."

Rest assured; all is not lost. In fact, it's quite the opposite. By knowing certain fundamentals—such as assuming control of the situation, providing education, and applying some healthy behavioral psychology—laboratory owners and managers can better serve these difficult clients. However, on occasion, the only solution for both parties is simply to end the relationship. That isn't always a bad thing for either party.

Unpaid invoices, poor impressions, inadequate dental-school training, miscommunication, misunderstanding of each other's needs, and a bad fit can all factor into the definition of what makes a client difficult.

"It's all of the above," says Justin Anderson, owner of Anderson Dental Studio in Provo, Utah. "The thing I've noticed about my dentists who may have some negative qualities is that they oftentimes have a counterpart positive quality. As our relationship starts and grows, if I focus on those positive qualities, it makes helping them overcome the negative ones so much easier. I try look at the obstacles of insufficient training, unpaid invoices, and miscommunication as challenges rather than roadblocks; my clients understand pretty quickly that I'm here to help their practices be more successful."

When asked about tough customers, many laboratory managers and owners say that often it's not a matter of being difficult, but rather it's miscommunication or a misunderstanding that stands in the way of a good relationship. This is where a technician's expertise and experience can be used to help provide CPR to a business relationship in crisis.

"A tough customer is someone who has difficulty understanding what the laboratory needs," says Robert Kreyer, CDT, co-owner of Custom Prosthetics in California. "I don't think anybody is difficult. We all have different needs and a different set of expectations."

He explains that from his perspective, today's newly minted dentists leave school with a significant disadvantage, one that students from previous generations did not necessarily face. About two decades ago, schools began trimming curriculums and made removable prosthodontics an elective course, no longer seeing it as a necessary component of a dental student's formal education. This has an impact on the dental laboratory, Kreyer says, because schools produce dentists who have little-to-no baseline for a quality impression or an understanding of what the laboratory needs from them clinically.

"It's part of our responsibility as technicians and the service we deliver to help them get from Point A to Point B," Kreyer says. "We need to help them plan a case, help them start with the end in mind and visualize the outcome. Dentists and laboratory technicians have a symbiotic relationship in which we coexist out of necessity, and that requires us to communicate effectively with each other. If we don't do that, then difficulties arise. We should always look at situations more as an opportunity, rather than as a negative."

Turning a negative into a positive is what Kreyer and his partner David Brandenburg are working to achieve through education. Last year they started the Implant Prosthetics Education Center at their laboratory, where the facility hosts hands-on courses for clinicians on behalf of implant manufacturers, such as Nobel Biocare, Zimmer Biomet, and Straumann.

"We're educating our clients on the latest materials, techniques, and how they can effectively determine the amount of restorative space needed," Kreyer says. "David and I believe that once they have a total understanding of our needs, it opens up a better relationship. We're here for the patient. We're here to make the best prosthesis possible. And that's the only reason we are here."

Keeping a patient-first attitude with clients helps create a learning environment where the small nuances of case management and treatment planning can be taught. Collis Prosthodontic Laboratory in Elmhurst, Illinois, conducted four seminars last year. "This is very important," says owner Jim Collis, CDT. "If the dentists don't know and understand the little things that can make or break a case, then the little things become big problems. You need to work with your customers, and the best way to do that is to educate them," he says.

Brandenburg notes that sometimes even the questions dentists ask could be telltale signs of an underlying need for additional education and clinical experience.

"Especially in the implant world, clients aren't sure if they are asking the right questions. Therefore, you're not always coming up with the right answers," Brandenburg says.

For those without the resources to start a training facility but who like the idea of educating problematic clients, more cost-effective means are within reach. What's more, educating a client can take on a subtle approach, says David Avery, CDT, AAS, Director of Professional Services at Drake Precision Dental Laboratory in Charlotte, North Carolina.

"When there is a problem, I call up dentists and say, 'I see you are struggling with this aspect of your technique, and I would like to recommend an article to you,'" says Avery, who has nurtured a passion for staying current on clinical dental literature for most of his career—an interest that has proven to be highly useful. In the conversation, Avery couples his comment with a suggested article written by a clinical thought leader, effectively providing a gentle but necessary nudge. "It immediately disarms them from thinking that I am being critical of them or that I am thinking I am more intelligent than they are by referring them to someone they respect," Avery says.

For the past 6 years, his laboratory has employed a full-time dentist who serves as its director of clinical education and research. "He operates as a licensed 'wet-fingered' dentist in his onsite operatory," says Avery, "and mentors clients at their practices to enhance their clinical technique or introduce them to new materials and procedures. He provides a tremendously unique educational resource to our technicians and clients."

Collis notes, "You need to work with your customers and the best way to do that is to educate them. Working with a difficult client and helping them achieve their goals can actually turn things around completely. They will be thankful and hopefully send you more work. We have to keep remembering that we are in a service business, and we have to keep providing that service."

Another option for educating clients is by working with the manufacturers who are eager to get into dental offices to demonstrate their product lines and best-practices techniques.

"We'll ask them: 'Doctor, you know what? I realized there is a problem with the quality of your impressions. Would you like to hear my opinion?' And most of the time, they do. They want to get better. We have the means to make that happen. We have very good relationships with our manufacturers," says Don Albensi, CDT, president and owner of Albensi Laboratories in in Irwin, Pennsylvania, noting that prefacing the conversation in this way helps soften what might appear to be criticism. The laboratory will reach out to 3M ESPE, Henry Schein, or the respective manufacturer or distributor to provide a lunch and learn at a client's office.

"They really contemplate before going to another laboratory because we helped improve their clinical technique and as a result the quality of the service they provide," Albensi says.

Communication is essential for all business relationships, yet it remains one of the biggest stumbling blocks on both sides of the equation.

"When anyone talks about a tough client, it has nothing to do with teeth. There is a breakdown in communication somewhere, as in you're not listening to me, you are not following my directions, you didn't mention something to me," Polansky says.

Technicians and dentists need to hone the softer skills of business—talking and listening—to help deal with the issues that arise, he says, adding that he reads books on the matter.

"What I usually do is have a heart to heart with them. I do it face to face," Polansky says. "Even when I have doctors out of the state, I ask them to Skype together so we can talk face to face."

Communication is the lynchpin for all relationships, says Larry Weiss, president of Keller Laboratories in Fenton, Missouri. "The biggest thing is communication. We need to listen and understand what it is that the customer is not satisfied with and where we disappointed them. Then once we understand that, we ask if there something we can do about it. Many times, in complex cases, it just involves one of our more experienced technicians sitting down with the dentist to find out what it is that they are looking for."

Money makes the world go 'round. So it's serious business when a client doesn't pay and the invoice balance due keeps growing each month. This is a delicate situation when dealing with this kind of difficult client—the nonpayer.

"We love making teeth, and we want the dentist to value us. But yet, if we're wise, we empathize with what the dentists are going through. They have bills to pay and families to take care of. As a business owner, I have to bury my passion for teeth when dealing with the numbers," Anderson notes.

Like some laboratory owners, Anderson doesn't like engaging the legal system or private-collections agencies when chasing revenue. He employs a softer approach, assuming that nonpayment is because the dentist is financially strapped. "I try to build them up. I'll send them a letter that says, 'It looks like you are getting behind. What can I do to help? And by the way, your preps still look great!' I have found this working-together approach has allowed me to collect a lot more money than using outside collection agencies or scary letters with red stamps."

He notes this strategy works well for him, and writing such a letter to one client who owed him $6000, whom he deemed hopeless, paid off, much to his surprise.

For larger operations, is a firmer hand the answer? Yes, says Albensi, owner of Albensi Laboratories, which is a mid-sized laboratory. The size of his laboratory and client base dictate that the personalized approach taken by Anderson would not be feasible or practical for his business. Albensi says that in order to keep the good quality, great price, and sufficient turnaround time, the laboratory cannot afford to extend payment terms.

"We have a good understanding of what we expect in terms of payment from our clients. If a payment doesn't happen, Susanne, our accounts receivable manager, who was once a dental office manager and understands the environment pretty well, can be sympathetic but also a little more demanding."

Keeping distance between the client and a payment due helps laboratory owners like Albensi avoid confrontational situations and lets them focus on the business.

Sometimes it's not really a matter of the client being difficult to work with, but more a matter of conflicting philosophies. Choosing a business proposition and sticking with it is key for a dental laboratory's success.

"You have to decide what type of business you are going to operate and what type of customer you are going to do business with," Avery says of the dental laboratory industry.

A mismatched dentist and laboratory are much like a square peg in a round hole, says Mark T. Murphy, DDS, FAGD, Lead Faculty for Clinical Education at Microdental/DTI Dental Technologies. "For example, suppose the doctor is a Kois or Pankey client and has really high-end esthetic demands, wants everything mounted on a certain articulator, wants to check things in the bisque state, and wants to check the case before you press it," he says. "Is the problem that he's not a good doctor? No. Are remake factors high? No. The problem is that your philosophy of the type of laboratory you want to run and the client's philosophy of how he wants to do dentistry are a mismatch."

Murphy points to the various price points of a product, which usually indicate esthetic differences. This dentist would have high esthetic expectations and pay the $330 price point. But if the laboratory were set up to create products on the lower end and its personnel and resources were geared toward that business model, it would be difficult for it to switch gears to work on a random higher-end case. For such a laboratory, investing in a high-end ceramist would not be financially viable.

"When you go to a one-star motel, you can be pretty sure that towel on the rack is not going to dry you off and the bed won't be comfortable. So when people with high expectations come to such a motel and call down to the front desk complaining about the lumpy mattress and the towels, the owner may be tempted to suggest they go instead to the Ritz Carlton. This is a mismatch of business propositions," Murphy says.

What the customer wants and what the laboratory is prepared to deliver do not meet in the middle, he explains. "When that happens, you have a choice to make. You can fire the customer because they don't fit you or you can find a way to serve that customer profitably," Murphy says.

Rather than firing the client, he advises adjusting pricing services for that dentist for profit, which may increase the risk of losing that client. However, this risk is worth the gamble.

Sometimes, though, the relationship just doesn't gel no matter how hard both parties work. Given the conflicting business propositions in the dental world, that may be for the best.

"We can work for all of the dentists some of the time and some of the dentists all of the time," Weiss says. "It's really hard to profitably run a business that works for all of the dentists all the time."

Jessica Birrell, CDT, owner of Capture Dental Arts in Saratoga Springs, Utah, had to handle just such a situation. When she noticed the amount of work from one client was starting to decrease, she called the client to find out why. It turned out he was unhappy that she couldn't provide the services and pricing of a large laboratory. "He was worried he was going to offend me, but I wasn't offended at all." She suggested he try another laboratory and gave him the names of some colleagues. "It ended up being great for both of us because I had some new clients who wanted to send work, but I didn't want to commit because I still had his account."

To be an effective business owner, it is important to recognize the challenges inherent in human relationships and be able to put them in a new context. Birrell finds it effective to work around a dentist who is not responsive and, instead, work through the dental assistants, who she says make good partners.

"I got tired of trying to explain to my clients why I need good prep shades and good impressions," she says. "Then I realized that it might be more effective if I explained my needs to the dental assistants, who are there to keep the dentist on track. They follow his routine or process, so they can remind the dentist about the prep shade and start to implement changes into the routine."

Now, Birrell provides laminated checklists for her clients. For her harder-to-manage clients, she offers incentives, such as gift cards or lunch, to the dental assistants to help them stay on track.

Trust is also paramount for building relationships, as Polansky notes. "When I talk to doctors, it's all about trust. I tell them I need them to trust me. It's like when I bring my car to the auto mechanic. I have to trust that he knows what he is doing," he says.

When an already-agitated customer starts hearing the word no, he or she might react adversely and the conversation can quickly spiral downward, says Deborah Curson-Vieira, who is the Customer Care Team Manager for Dental Prosthetic Services in Cedar Rapids, Iowa. The key is to keep the conversation positive and to be working with the customer.

"We do whatever we can to say yes to a customer—it is so important," she says. "We talk about it pretty regularly in our customer care group training. If customers' expectations are unreasonable or if there is something that we can't say yes to, we must also try not to say no. We let the customer rant and rave, taking care to listen to what we are hearing. Then we try to get the customer involved in the solution by saying, 'What would you like us to do?' If we can't resolve the expectations, we say, 'I can't do that, but here is what I can do.' This really seems to work well for us."

Collis says practicing kindness is key. "My dad, who was a very good businessman, always told me to never give them a reason to go anywhere else. Kill them with service, kill them with kindness."

All relationships, whether good or difficult, ebb and flow.

"Just like personal relationships with family and friends, you may have difficult moments but approach these relationships with a genuine care for them. You want to resolve whatever problems may arise, looking past each other's shortcomings, seeing the person they can become," Birrell says. "Sometimes clients may be having a tough day, but we are on the same team. We want to achieve the same final goals of helping the patient and obtaining success in our careers."

Above all, know your worth as a technician, Polansky says. "Laboratory owners and technicians usually don't meet the patients they help. They only know if they are good by what the dentist tells them. The bottom line is, know what your competency is and be tough like the dentists are."