Michigan Instruments Blog

Mondays are busy days, and especially so if you  are in charge of maintaining a
company’s international relations.  You may go home for the weekend, but that does not mean that there is no business being done.  Fortunately, here at  Michigan Instruments, it is not uncommon  for a gentle, encouraging bark to break the air:

“Don’t Panic!”

Angie Kulesza, our office administrator, customer service representative, secretary,
treasurer, corporate officer, and general fixer-of-problems, has taken the case.  Currently, she is calmly explaining the shipping process to several stressed
employees while transferring a few calls over to the sales office.  Angie considers herself a customer service specialist, and 15 years of human resources experience back up her claim.  “ I handle most of the government and foreign accounts...it is very important that they be carefully maintained.”  She is quite right.  The medical industry is nearly unique in that many of our customer/client relationships are
decades long.  It can sometimes take years to turn a potential customer account into a bona fide buyer, but to Angie it’s always worth a little extra time investment. 

“It’s important to keep a cool head,” she explains to me, “[even though] when we get a government order it’s always a rush.”

Angie is very enthusiastic about the customer relations aspect of her job, and this serves to highlight the fact that many of us here at Michigan Instruments wear
several hats.  Angie has been an employee here since 2003 and has grown to cover domestic government relations, international relations, and many things in between.  She’s come a long way from the farm that she was raised on, but the principles are the same: finances, shipping, receiving, and customer relations.  All of these need to be accounted for and balanced out.

“It’s about helping people.”  She concludes.  If you can satisfy a potential client you’re just a small step away from making them a customer. 

Medical technology is a highly competitive field that demands attention to detail at every turn.  When a device fails it can result in lost lives.  This is as true in the manufacturing and development sectors of the industry as it is in the clinical realm.  In order to maintain the integrity of both our products and our mission it is mandatory that we communicate well. 

This might seem like an easy goal at a small company like Michigan Instruments, but in truth it remains an issue.  Many MII employees have been with the company for more than a decade and have grown to see the others around the workplace as a sort of family—a family that they may be hesitant to distance themselves from by bringing up touchy subjects.  So what do they do?  They avoid the topic.  When people fail to bring up these ticks that bother them communication suffers.  Dodging a given subject can, in time, lead to outright avoidance.  Employees avoiding each other is a problem for any company, particularly one as small as we are. 

In an attempt to head off such problems, a few communications experts from Creative Solutions Counseling were brought in to our headquarters.  During their visit I, along with the rest of the MII workforce, got a full rundown on the importance of good communication in the workplace.  We were given tips on how to recognize poor communication as well as advice on how to foster good communication.

The question that most people would ask is simple:  “Did it work?”  In truth, only time will tell.  I would not say that I have become a communications expert from attending their help sessions, but I would say that talking about possible communication issues brings the topic to the front of people’s minds, making it a less-awkward subject to broach.

Let’s get one thing straight—there are going to be some companies that show up at trade shows with $10,000,000 booths that have entire sections of their company devoted to analyzing exactly how they will appear best in the exhibit hall.  This is not a list of recommendations for those companies.  Most of us find ourselves stuck with a semi-comfortable 10x10 with a rock-hard floor that we may or may not be sharing with another exhibitor.  This can make the larger companies seem intimidating at best and insurmountable at worst. The fact of the matter is that you can get scores of people flowing through your booth without breaking your budget.  Here’s how:

• Bring your product!  A picture will not suffice.  It doesn’t matter if you are selling disposable breathing hoses or a 10-ton MRI.  People like to be able to put their hands on something.  If you’re selling software put it on a tablet and let people mess around with it.  It’s not always easy to get your product on the show floor, but it’s always worth it.  If you have been working with a product for a number of years it is very easy to assume that attendees just know what it is and how it works.  This is almost never the case!  The best way to let them learn is to have the unit there for them to play with. 
• Make sure that your booth can be spotted/located from across the hall.  Not every person that walks past your booth will be a potential customer, but everyone that walks through has the potential to know someone else that might be interested.  Impress someone enough and they will start to advertise for you through word-of-mouth.  Now, being easily spotted from across the hall does not mean that you have to have a million-dollar kiosk that hangs from the rafters.  I remember seeing one innovative exhibitor take a $200 projector, set it to music visualization, and point it toward the ceiling.  No one had trouble finding his booth, and I’ll bet a fair number of people stopped by his table just to see what was going on. 
• Make sure that the people that you talk to remember you.  One of the best ways to do this is to give something away.  Now, putting a bowl of candy on your table doesn’t count.  It has to be something that they will have to come back later for, preferably involved in some sort of competition.  Recently, I have been running a contest at various EMS shows to see which attendee can do the best bag ventilation, offering a free net book as the grand prize.  Now sure, the computer costs a bit of money, but the added interest that you will get will certainly be worth your while.  At the EMS Today show in Baltimore last month I must have had 30 people stop by my booth for a second time just to see if they were leading the competition.  Most of them stayed to chat about the products.  Some only turned into leads after their second visit. 

Make sure that you are eye-catching in an appealing way.  Wear a smile and don’t be too zealous about your product.  Make sure they see you and that they remember you.  You may not look like the biggest fish in the pond, but a good strategy will get your company and products stuck in the heads of attendees like a song.

International distribution is both an obstacle and an opportunity for many modern companies.  Michigan Instruments has been doing business with Beijing Ji Yuan Electronic Co., LTD. (BJY) since 1996 and it has been a mutually beneficial relationship.  Finding a good distributor can be difficult, especially in the medical field.  Launching a product for the first time in a new region further increases the challenge.  Neither BJY nor Michigan Instruments backed down from the challenge, however, and it has worked out for the best. 

How did you get started in the field of medical distribution?

BJY was originally a manufacturer of medical supplies.  This allowed them to create roads into the market that have been key to the success of the product launch. 

How are the market segments of medical simulation and emergency response divided in China?

Emergency response is certainly the larger of the two.  BJY sells emergency response equipment to many major hospitals.  Simulation equipment sales are closed only at several major universities.  Simulation exists almost exclusively within the field of higher education. 

What types of changes would you like to see for continued success in the Chinese market?

BJY hopes to see mechanical CPR become the national standard.  Now that our mechanical CPR products have been launched successfully we would like to see the market continue to grow. 

How is the respiratory care market changing in China?

The market is expanding.  Whereas the USA has more than 200,000 trained respiratory therapists China registers less than 2,000 per year.  Demand for RT's and training equipment is expected to grow quickly over the coming years. 

We are very proud to be working with BJY.  Our companies have been working together since 1993.  It has been an extremely beneficial partnership.  For anyone looking to market their product in China the first step is to realize that it is almost impossible to do alone.  Successful international distribution requires a partnership. 

Every modern, for-profit company has a salesman of some sort, and it is important that that body be both approachable and savvy.  One of the worst things that a salesperson can do is to misinterpret the value of his or her product.  Where does a product’s value come from?  Materials and labor, sure, but that is only a small part.  Convenience and applicability certainly play a role.  Demand is a factor to consider, also.  In short, if your product is needed and handy, it’s going to be worth considerably more than the raw materials that are put into it.  It is possible to have a million dollar idea—the problem is making sure that your potential customers don’t overlook the value of it.  Victor Frigo works to ensure that Michigan Instruments’ products are not overlooked.

What is your title here at Michigan Instruments?

Outside Sales Representative.

Please describe some of your previous work experience.

I have been responsible for sales growth and new business within the Midwest in companies such as Hallmark and TY over the last 31 years.  I have worked with large and small customers throughout my career. 

What are some “key factors” in getting a sale?

1. Overcoming objections—no matter what you are selling, prospective customers are going to have questions and  concerns.  Reassuring and encouraging the customer is always the first step.  Make sure they know your product.
2. Value—with any product there will be some items that don’t come in the box, and these are often the most beneficial.  What values does your product offer the customer?  Make sure they understand these.
3. Having the best item at the best price—This does not necessarily imply that you are selling the cheapest product, but rather that you offer the best dollar-to-value ratio. 
4. Success is based off of finding customer needs and adapting to fulfill them. 
   
   
   

“Added Value” is a term that is becoming increasingly popular in modern marketing speak, especially in the medical realm.  What is an approach that you use to help show the value of your products?

At Michigan Instruments customer service and support here are excellent.  All repairs are done here at the office/factory, right where the units are made.  The fact that we are a single-location company lets us keep a close eye on all of our units and ensure that repairs are accomplished effectively. 

As a sales representative, what is the best part of your work day?

Discovering a new market and expanding our sales base.  If I find more shows to attend and more channels of distribution I am achieving my goals. 

How could Michigan Instruments foster a better sales department?

By working more closely with distributors.  We need a solid distribution network.

Medical science has exploded over the last 100 years and it can be difficult to find all of the places that your unit can fit.  The search for new markets for mechanical CPR and lung simulators is unending in the truest sense of the word—as the industry expands new uses keep popping up.  The more widely applicable a device is, the greater the “added value” that it generates.  The greater the added value, the more imperative it is that its usefulness be clearly communicated to the customer.  Medical sales requires personnel that are able to adapt to an ever changing marketplace. 

Quality assurance is an integral part of any medical manufacturing company, and the term does not always mean a review of the company’s finished product. A word that may not always be associated with a quality assurance unit is “infrastructure”. Joseph P. St. Martin IV heads up the quality branch of our company and fosters a very unique view of what such a position entails.

What is your official title here at Michigan Instruments?

Quality Assurance Inspector

Before becoming a quality overseer, what was your previous position?

I was in construction management, responsible for overseeing the day to day operations of several job sites and ensuring that all installations of infrastructure were performed according to print specifications and industry standards.

What is the most enjoyable part of your day?

I think that the best part of every day is the fact that I get to work with a team of people that are dedicated to producing products that are built to very specific details and regulations, ensuring that the products that we ship are the best in the industry and that they perform flawlessly for those in the medical field that use them every day. For that to happen a business has to have avenues of information that are easily accessible to Quality personnel. At Michigan Instruments the door is always open for us to these information avenues, be that a document control issue, a regulatory issue, an engineering issue, a production issue, or the fact that the President of the company, my direct supervisor, maintains an open door policy at any time for any reason. By taking all these avenues and putting them together, Michigan Instruments has enabled not only its Quality personnel to be able to perform to the highest level, but all managers and supervisors to have access to these resources for their specific departments, thus strengthening the company as a whole.

What, in your opinion, is the most important part of a quality review?

The important part of a Quality Review is to assess the effectiveness and efficiency of the department based on current standards and regulations, and in doing so you identify areas to improve the process within the department.

What is a sure sign of a good Quality Control policy?

That the department is meeting all the requirements as stated in the company’s Quality Control objectives and company manufacturing certifications.

What advice would you offer to a person considering a career in quality management?

I would say that most everything in quality relies on multi-departmental teams working together to accomplish the company’s goals and objectives. To this end a Quality Manager must have good customer focus, good leadership, and good people skills and possess the knowledge and technical skills of the products being produced. You may not have 100% knowledge in all of these areas when you start, but if you are motivated to continue to learn and improve your skills you will do well in Quality Management.

A good quality assurance system can be identified by happy, efficient employees combined with a clear, concise inspection. Joe believes that good policy begets good product. Medical devices fulfill niche roles and are thus manufactured to very demanding standards—ensuring their quality is well worth the cost and effort.

There are many situations in which the performance of ventilators or similar respiratory care equipment must be tested.  Perhaps the most common is in the Biomedical Engineering department of a hospital, where preventative maintenance testing is routinely performed for a wide variety of medical equipment.  But there are many stages in a device’s life cycle at which testing is warranted.  Development engineers need to test new ideas and mechanisms as new ventilator technologies are developed, and Production and Quality Control engineers must calibrated and assure the performance of the machines during manufacture.  As wear and tear from use take their toll or problems otherwise develop, service personnel need to troubleshoot the systems in order to locate any problems and effect appropriate repairs. 

In practice, many different types of equipment are used to test or otherwise assess the performance of ventilators and similar respiratory care equipment.  These range from simple flow measuring devices, to electronically instrumented, flow meter based “ventilator analyzers”, to fixed and variable volume test lungs, and finally all the way to instrumented, computer controlled, spontaneously breathing lung simulators(1).  While each has their own advantages and disadvantages in terms of capabilities, convenience and cost, for most testing applications it is essential that at least the basic parameters of pulmonary compliance and resistance are realistically simulated. 

A realistic compliance load, in particular, has profound effects on gas flow, the action of many ventilator components and on the performance of ventilators and similar devices in general.  In fact, standard-setting organizations like ASTM and ISO mandate that ventilators be tested under conditions simulating actual use, and using realistic compliance and resistance loads in particular (2).  Gas is a compressible substance, and even at the relatively low pressures used in Respiratory Care, volume and flow rate measurements are very sensitive to changes in pressure.  This characteristic affects ventilator testing in a number of ways; here are a few examples:

1. In order to test the accuracy and reliability of flow and volume sensors that are so frequently part of modern ventilators, pressures and changes in pressures must be realistically simulated during testing of such machines. 
2. Gas output as part of a breath delivered by a ventilator, but which ends up compressed in the breathing circuit, never makes it to the patient.  While many ventilators include sensors and software systems designed to compensate for this common phenomenon, complex mechanisms like this must be tested frequently to ensure their continued integrity and patient safety.  Only by realistically simulating the compliance and resistance characteristics of use conditions is it possible to test such systems. 
3. Many components of ventilators, and especially many components of breathing circuits used in conjunction with ventilators, are designed to work with and respond to specific flow and pressure conditions in order to function properly.  Only by realistically simulating the conditions under which these components are designed to operate can they be made to work correctly.  Testing under any other conditions will cause these components to function differently, which can affect the apparent overall performance of the ventilator, and which denies the technician the ability to accurately assess the performance of the components themselves.

Pulmonary compliance changes throughout the inhalation and exhalation phases of a breath; this is as true for test lungs as it is for real, human lungs.  The Training and Test lung and PneuView system (both produced by Michigan Instruments) correctly and accurately model the dynamic compliance characteristic, in addition to upper and lower airway resistances.  Each lung is calibrated individually, and each installation of the software system is tuned to specifically match the lung it is connected with. 

The Michigan Instruments, Inc. TTL is designed to simulate the pulmonary characteristics of patients of all ages, sizes and conditions.  With the addition of the Breath Simulation Module, these devices may also be used to simulate the spontaneously breathing patient.  The package of hardware, instrumentation and software provides an unparalleled capacity for testing all types of respiratory care equipment under conditions simulating those of actual use. 

In a clinical setting, the concept of “ventilator performance” takes on a larger meaning.  Even ventilator systems functioning exactly to specifications perform differently depending on the particular patient or other use conditions presented in various real life situations.  Even within a specific ventilator system many different modes of operation may be available, and the modes most appropriate for use in a given situation may be subject, at least in part, to certain patient or use conditions.  Realistically simulated patient loads can be invaluable in these situations, and care givers can make effective use of test lungs to allow the widest possible range of treatments to be investigated before application to the patient. 

For training and teaching applications, use of a realistically simulated patient is also essential.  Training the use of ventilators and the employment of various respiratory care techniques to medical professionals requires fidelity of the training scenarios, equipment and materials to the real-world, clinical setting.  Training and test lungs provide the ability to simulate a huge variety of normal and pathologic pulmonary conditions, and cover the range from very small infant/pediatric to very large adult settings.  Training and test lungs can also be used to simulate the spontaneously breathing patient; it is only through such simulation that some of the more advanced modes of ventilation, such as assist/control, IMV/SIMV and pressure support can be taught. 

(1)    Anderson, JA: Ventilator Testing Comes of Computer Age.  24x7, June 2003, 35-39.

(2)    ASTM: F1100-1999 Minimum Performance Specification for Critical Care Ventilators.

Medical equipment is almost universally classifiable as “niche hardware.”  Most devices only attempt to cover one area of use, but these tend to be ideal for application in that field.  That being the case, they are often a hard sell.  It’s a matter of getting the equipment into the right hands and having the ability to communicate to the end-user the scope of the benefits of the product, which may not always be obvious.  For these reasons and others field experience in salesmen is a much sought-after qualification in this industry.  Dave Keister, a Michigan Instruments sales representative, worked as a field paramedic for years before moving into the sales realm and attributes much of his success to his previous experience. 

What position did you hold prior to your current one in sales?

I was hired at MII in February 2005 as a service technician.

How long were you in the industry before moving?

I worked as an “active” Paramedic for about eight years here in Grand Rapids.

Why did you pursue the career change?

After working as a Medic I was offered a position with a Plasma Center as the Medical Supervisor. The company I worked for was sold to another Plasma donation company and the new future of the company looked rather bleak and I started looking into medical manufacturing.

What advice would you give to an EMT or RT considering a career in sales?

To keep your current license up to date and stay on top of continuing education in your field.

On a scale from one to five, how helpful has your clinical experience been in sales?  (Please explain your answer)

Five-I feel that all medical professionals have great disdain for sales rhetoric and appreciate a sales professional that knows the field they are selling and like a “peer” level approach from their sales person.

Talent in the sales realm is also a prominent factor, but the medical field is an area in which knowledge of product application is particularly valuable.  It can help to eliminate miscommunication between consumers and manufacturers in a way that books and seminars alone would never allow for. 

Pseudo-stratified, ciliated, columnar epithelium with goblet cells might sound like a mouth-full, but when you break it down all that that really means is: tall cells packed closely together with microscopic hairs on top, and nuclei at different heights interspersed with mucus-producing cells.  So….why is this important?  These cells litter the human respiratory tract and are among the ones most damaged by smoking, the common cold, and improper ventilation.  As members of the medical industry it is absolutely mandatory that we account for as many scenarios as possible, for instance knowing that a smoker is going to have decreased airway resistance due to the death of the microscopic hairs on the top of these cells.  Some major tissues in cardiopulmonary treatment include:

• Cardiac Muscle—easily distinguished from other bodily muscles by the thick bands that cover it (striations).  This muscle tissue is rich in mitochondria, allowing for fantastic rates of aerobic respiration (energy production requiring oxygen) resulting in negligible muscle fatigue.  IMPORTANT TO NOTE—anaerobic respiration (energy production without oxygen, aka lactation) produces lactic acid, which will fatigue the heart.  Fatigue becomes critical for cardiac muscle at an anaerobic respiration rate around 10%.  To avoid excessive lactation during CPR, make sure that the patient is well and properly ventilated.

• Arterial Vascular Tissue—Blood vessels leading away from the heart that carry oxygen rich blood used in aerobic respiration.  IMPORTANT TO NOTE—arteries function off of blood pressure.  If an artery has been severed extreme discretion should be used when applying CPR to the patient, as the profusion pressure created by the treatment may result in additional blood loss and damage.

• Vein Vascular Tissue—Blood vessels leading to the heart.  Carry waste rich blood excreted by the pulmonary system. IMPORTANT TO NOTE—profusion in veins is not controlled by the width of the vessel but rather by muscle action.  A paralyzed patient may have decreased venial profusion due to decreased muscle action.

These are only small examples of the effects that tissue quality has on the cardiovascular system, but they help to illustrate how delicate the system can be.  Thousands of different tissues exist.  In any case, the most important factors in the success of any medical undertaking (including CPR) are knowledge and an ability to adapt.  Through the use of mechanical CPR, adaptations can be quickly and accurately made in accordance with the instruction of a qualified user.

As a pool of information grows it becomes increasingly important to condense its parts down to a more manageable size.  Use of acronyms is an excellent way to accomplish this and it is seen in almost every modern field.  What follows is a list of a few potentially confusing acronyms that anyone poking around our mechanical CPR lab would run into.

1. CPR-Cardiopulmonary Resuscitation-The process of compressing the chest of a patient while delivering asynchronous ventilations with the hope of achieving ROSC.
2. ROSC-Return of Spontaneous Circulation-The end goal of all successful CPR efforts.  If a patient achieves ROSC, CPR should be discontinued immediately. 
3. NRV-Non Rebreathing Valve-A valve used in ventilation to ensure the dispersal of “old” air.
4. PDV-Patient Demand Valve-A valve used in ventilation allowing the patient to receive air when they attempt to inhale (not necessarily at the same rate as ventilation). 
5. ETCO₂-End-Tidal Carbon Dioxide-a measurement of the CO₂ produced by the body.  ROSC is more likely in cases where the patient has a high ETCO₂.
6. EMT-Emergency Medical Technician-Trained professional competent in CPR as well as other medical procedures
7. AF-Atrial Fibrillation-uncoordinated movements in the heart commonly resulting in cardiac arrest. 
8. AED-Automated External Defibrillator-A device that attempts to undo cardiac fibrillation by shocking the patient.
9. ECG-Electrocardiogram-an electronic display depicting the movements of a patient’s heart
10. CO-Cardiac Output-A measurement of how effectively a patient’s heart is functioning.

A working knowledge of applicable acronyms is mandatory in the clinical setting, and as technology progresses more and more find their way into common use.  A large database of medical abbreviations and acronyms can be found at http://www.medindia.net/acronym/index.asp. 

Are there any acronyms that you are having trouble identifying?  Was this article helpful to you?  Please leave a comment below!