Creating an SOP, Quality Control, and Training Master System

My brother and partner, Greg Killian, asked me several years ago to create an SOP (standard operating procedure) master system for training and creating consistency of quality, day in and day out, for our medium-sized laboratory. However, no longer working at the bench at this point, I was checking every case personally before giving it my stamp of approval, so I did not feel the need. After all, I was the SOP master system. How short-sighted that approach was!

Upon turning 70, I began to ask myself: Who will perform these tasks in the future, how will the knowledge be passed on to them, and how will they attain the same consistent level of quality that I expect? Even in the short term, growth cannot be achieved if the person responsible for training and quality control is already overworked. I could train the next generation, but who will train the one after that? Using only over-the-shoulder training, will this end up like telephone tag, where quality slides with each new person?

The answers to those questions are not easy to come by, and until last year, I never would have dreamed that I would be finishing up this "master's thesis" of a project. On behalf of Spectrum Killian Dental Lab Alliance (SKDLA), I began implementing an SOP/quality system called the "5 Star Quality System." Most of the documents in the system are dynamic and upgradeable. It is scalable for our rapidly growing laboratory group. It is easy to use and understand, and it will be used to train and maintain quality for many years to come.

When all fingers on our SKDLA leadership team pointed to me to make this happen, I must admit that I shrank in fear that this would be way over my head. What we found was that the process is actually quite simple, but it does require time, thought, and coordination. The concept was borrowed from other industries—mainly aerospace—where processes and procedures are highly documented, with specific measurements, tools, and photographs to ensure the success of a manufacturing step.

We started with the first department where cases enter the laboratory: the disinfecting department. As a Certified Dental Laboratory (CDL), we already had a printed document posted that outlined the step-by-step procedure for disinfecting. That was easy. With the input of those who used it every day, we refined the document and added a couple of photographs showing the work area and how it is set up. Materials needed are specifically listed and SKU (stock keeping unit) or re-order reference numbers are included. All measurements and tools are mentioned. Every step in the process is listed in order, much like a checklist with detail.

In other departments, the use of photographs and YouTube Shorts videos added color and clarity to the words in each step. For instance, how would you describe the work of a Master Smile Design Diagnostic Waxer? I can shoot still photographs all day and still not get the message across with perfect clarity. Add a video of the technician/artist carving and stroking the bulk waxup into a polished and refined product, and now you have something that can be utilized for training. Most videos need to be short—less than 60 seconds—to communicate simple processes. Some advanced-level techniques can take several minutes to record. Get the best smartphone available to shoot your videos and upload them. It is actually easy and fun. Today's smartphones take amazing close-up videos. Because some of your processes may be proprietary, you will want to select a private setting before publishing so that only those who have access to your SOP training system can use the links to the videos.

It was important to not attempt to reinvent the wheel during this process. All of our major manufacturers have beautifully detailed instructions for use (IFUs) available in digital form. We downloaded them and highlighted specific pages that illustrate the processes that technicians must follow. We put the downloads in a "Reference Document Section" for each department. Not all processes performed in your laboratory are documented in the IFUs, so you will need to carefully think through and document what is missing or what is different with words, photographs, and videos.

Keep your documents as simple as possible so they are easy to read and understand. Boil down some lengthy SOP instructions to short "quick guide" type checklists where possible. Use the quick guide as a summary at the end of a long SOP. You can print the quick guide, laminate it, and tack it up in the work area where it is being used.

Once we had polished up the documents for several departments, implementing the SOPs was the next big challenge. In order to verify that all of the technicians in each department had read their respective SOPs, we developed simple, 25-question tests. No technician is permitted to work until they can pass the test with at least 23 correct answers. At the time this was written, everyone had passed on the first or second attempt.

For the long term, department managers are tasked with verifying that the technicians under their supervision are performing the processes correctly. Department managers need to possess the most expertise with the SOPs. Choose a regular interval and then document the process performance verification for each technician. It is easy to simply watch a technician perform the tasks in a process.

Quality control is a never-ending process of education, training, and improvement of processes. After all, the pursuit of excellence is all about change—for the better.

Review and upgrade your SOPs regularly, especially as new machines, software, products, and procedures are being introduced into the laboratory. Keep your department managers informed of the changes. Set a regular SOP review schedule for managers and their teams, or simply review after significant changes have been made. These documents become a powerful onboarding and training tool, setting the quality standard from Day 1.

Steve Killian, CDT, was the President of Killian Dental Ceramics and Co-Founder of Spectrum Killian Dental Lab Alliance in Irvine, California.