This is how orders generally proceed where I work: First, a customer takes an impression of someone's feet or foot. This package is boxed up, sent out and we receive it in some condition. If the cast or box is in good shape the lab enters an order and prepares a product according to specifications. For the rest of us who are not in the lab a schedule is posted of turn around times - generally it's a pretty safe assumption that an order will be done in a week so unless there is something special about an order that's what I tell people who call for a status check.

One of my best and probably favorite customers is in Texas. At the beginning of August he called with a situation. The majority of patients our customers see are elderly however there are statistical outliers in the mix. Most people are ordering shoes and inserts from us however occasionally people send in shoes for modifications or for templating purposes. After a discussion with a pedorthist in the lab my customer was advised to send in the shoes along with the foam impression box. Medicare and Medicaid both have time restrictions on how long paperwork is good for so customers make every effort to get their orders processed in a timely fashion.

Last week my customer called to check on the status of his Medicaid order. These particular shoes and inserts are going to a four year old boy whose great toe is gone and what makes his case unique is two of his four remaining toes are joined together leaving him with fourth and fifth individual toes. As you can imagine this boy has a great deal of trouble walking due to his unnaturally shaped foot and missing great toe. My customer spent some time on the phone with the lab discussing the best treatment modality and it was eventually decided that the boy would outgrow a toe filler too rapidly so accomodations were made on his impression box and a combination of materials are going to be used during fabrication to help modify and correct his gait.

The guy I work with is generally easy going. He's from down South so even when he's upset he's polite. When I went back to the lab to investigate no one could find an order, paperwork, shoes or a foam impression box belonging to this patient. Our lab turns out between 500-800 pairs of customs a day, the lab manager is good and when they told me they had never received the order, I believed them. I went back, called my customer and discussed an action plan. They had not kept a tracking number so we really had no idea if we had ever received the shoes or not.

I went back to the lab a second time because I know this practitioner well and if he said that the shoes were sent along with instructions I knew that he sent them. Again, everyone denied knowing anything about the patient in question. One of the guys who works in the lab directed me to the returns room. They process all incoming boxes regardless of their final destination and after searching through every page starting on August 11th, I found the entry I needed. On August 18th we had received shoes and a foam impression box but where they had gone since then was still a mystery.

Again, I went back to the lab trying to control my anger. I asked everyone if they had seen a pair of very small extra depth shoes and got another round of negative responses until a newer girl stood up and said that she had seen them on a supervisor's desk. I picked up the tiny shoes and asked the crew when my customer could reasonably expect to receive this order since the clock was ticking on the Medicaid paperwork. Most of them shrugged, a manager told me that they had just been told that all inquiries were to be conducted via email and no one should be back in the lab. No one had told me that so I filed that for later and asked about the turn around time.

She told me that the guy who runs the lab had been out on vacation and while I am all for people taking vacations if they have the time I do not want to go back to a customer whose order I thought was lost and explain that it sat for a week on someone's desk because no one had even bothered to enter it into the system. This is the kind of situation I hate. In the past when I've sent emails to the lab they do not get answered in a timely fashion and when they are answered there's a textbook passive aggression about the stingy information. My job is to sell, their job is to produce orders and lately I've had a couple customers complain about turn around time.

If there is a situation where the lab is busy and falls behind I understand that. If that is the case then all I want is someone to tell me that a milling machine is down or several people are out and they are shorthanded. What I'm going to propose to my boss who returns emails when she damn well feels like it is a twenty-four hour response time. When people are out they can set the out of office bounceback email otherwise my belief is that people should be able to answer emails within 24 hours. This probably won't fly for many reasons but I am thoroughly fed up with people not getting back to me and going back to the lab with queries on orders only to hear that they have no idea why an order that should have been shipped days ago is still sitting in the system.

Some of our customers are people who do not care. These are not the people I like to work with. I like working with people who are too busy to talk to me because those are the people who are getting people into shoes. There is a lot of pressure on my department to rejuvenate customers and I can only sell products I believe in and know well. I can sell the lab better than anyone else in my department since I have more technical and mechanical knowledge about how things work and what different materials can be used to create a functional custom product. Government standards are a joke in my opinion. People are getting ripped off, cheated out of what they deserve under the Therapeutic Bill for Persons With Diabetes aka TBPD. 

My department tracks sales by channel. Customers can be divided into pharmacies, Durable Medical Equipment suppliers, podiatrists, O&P (Orthotics and Prosthetics) and C-Ped (Certified Pedorthists). There are other smaller channels such as the VA and hospital channels however those are handled separately. Each channel has their own set of challenges and advantages. Pharmacies and DME's understand the retail aspects better and I believe that those markets are poised for growth as insurance policies cover less and less. Podiatry has the paperwork advantage however most podiatrists are small business owners with limited staff that is expected to do everything.

Our department was formed to contact customers whose sales had decreased and determine why. Some of these accounts have been brought back to life simply because we picked up the phone and called. Other accounts are still down or have quit dispensing altogether because the paperwork is too much of a hassle and they feel that diabetic shoes are not profitable any longer. In my opinion orthotists and prosthetists are some of the best people to work with for the following reasons: although they are busy they are generally willing to explain why they are not dispensing. They are among the best fitters and return the fewest shoes. They are passionate about what they do and as a group I feel they have more integrity and higher ethical standards than any of the other groups.

It frustrates me that I have to sit across from a man who cares about sales and not people. I hope he doesn't last long and if management is smart they'll get rid of him because he is lazy, insubordinate and lacks passion. Management has designed a spreadsheet for us to track calls by channel. I hate this spreadsheet because I have to enter every call twice and the spreadsheet tracks only calls, not letters, faxes or emails. Although I don't do a ton of business via email it is an undeniable part of my day and what really upsets me is it is a numbers game so if three people all made 22 calls during a day the assumption is that those three people all did the same amount of work.

I want a quality metric installed into the system. You can't grade an email that asks me how my weekend was but what that says to me is these people are my friends. Friends do things for each other that they are unwilling to do for others. I go out of my way for my friends and sometimes that makes my job difficult because I want to tell my friends that they should be asking for more but that would not be in the best interest of my company so I can't. At the end of the day I can go home knowing that I have made a difference in the lives of literally thousands of people that I have never met.

Good practitioners deserve all the breaks they can get only life isn't always fair. I try hard to make things fair for everyone. Cultivating relationships is an art form. At times I am too aggressive, I've lost people that way however the other day I read a great Steve Jobs quote that helped me realize that what others think or do doesn't really matter. Maybe I'm not being rewarded the way I feel I should be however I have to think about how my customers treat me and one of the greatest compliments someone in my department can get is positive feedback from the inside. A guy I respect told me that if he was a customer he would want me to be his account manager. 

Another compliment I received was non-verbal but after a customer of mine asked me to help sell a program I wrote I thought that he must think highly of me if he thinks I can sell his work to others. The first four people I called were interested, I think his program needs a little revising but in terms of data extraction and tracking it is excellent. Impatience is one of my largest failings. I can see things so clearly and I forget that building an empire takes time. Eventually I want to reach the consultant stage where people call me because someone I've worked with in the past has recommended me. Maybe someday I'll be there but for now I have to realize that I still have much to learn.

Today I played catch with the girls in the yard. I hit my youngest in the forehead with a baseball and by the time she left for brunch I could see that she is going to develop a nice bruise. What impressed me the most was after a rest period with a cool pack she came back out and picked up her glove again. I have good memories of my father playing catch with me when I was a little girl. Perhaps time out in the yard will not stick with my children when they are in their thirties but for me, today, it is enough. I never know what shape my mind, body or spirit is going to be in so I have to take my cues from others who have things worse than I do and just make the best of what I have here and now.

Until next time,


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