Sales reps can work for you or against you, bailing you out of a supply jam the morning of surgery or ducking your calls about that missing implant. I suggest you hold your reps to the same ethical and performance standards you've set for your staff. Here's how to do just that.

Interview the candidates.
During the initial meeting with a rep, interview him to see what kind of rapport you establish (see "5 Questions to Ask Your Sales Reps"). Selling experience is a key consideration, but not an essential requirement. Some of the best reps I've worked with are ex-surgical techs. They were short on selling experience, but long on time spent in the OR.

I'll also ask a rep how long it will take him to get back to me when I leave a message on his cell phone or with his answering service. Will he call back by the end of the business day? Within 24 hours? Before I buy from him, I'll test his answer with the actual amount of time it takes for me to get a response. His rate of response will let me know if he's a man of his word; I'll also be able to judge if I can live with how long it takes to get a call back.

Also address the protocol for making a sale at your center. I often see reps bypass administrators and head straight for the surgeons to make a sale. Don't forget, you control the budget and make the recommendations to the center's governing board before equipment is purchased. The reps must come through you.

Research relationships.
Research the relationships between your surgeons and sales reps. A rep once told me that he and my doc were great friends, and had worked well together in the past. When I asked my surgeon for feedback about the company and the vendor, he told me he couldn't stand the rep. Do your homework - some people will tell you anything for a sale.

Work with decision makers.
How do reps rank in the company? Do they have decision-making power, or does everything have to pass by their supervisor? It's a huge hassle if a rep constantly says he needs to run a price request by his manager when you're in the middle of negotiations.

Set OR guidelines.
Vendors who enter the OR must respect both the staff and the patient. They should minimize time spent in the OR by coming in after the patient is prepped and draped. Reps need to stay out of the staff's way, yet be present to clarify equipment set-ups or questions that arise during the procedure. While in the OR, reps should take cues from the staff and remain in the room until the case is complete. The only time a rep should be allowed to leave and re-enter is when the surgeon requests a piece of equipment that is not in the OR, and it is something the rep has in his possession.

Some companies require their reps to complete a course on infection control and sterile technique. The class teaches them how to wear the mask and scrubs, proper traffic protocol and what they can and can't touch in the OR. Reps who've passed this class will often have it documented on the back of their business cards. They are usually proud of this, and will point it out when you meet them.

At the very least, have reps sign in and out of your facility. They must always wear a nametag and accompany the surgeon whom they observe. The patient must also sign consent for observation release before a rep is allowed to watch a procedure.

Demand loyalty.
Your reps should be ambassadors, supporting your center in the community. Word got back to me that one of my reps badmouthed my center during a call to a competing facility in town. Ouch. He talked about our cases, his impression that our staff was incompetent and that our equipment didn't work. None of it was true. As far as I'm concerned, we should report reps who don't act in a professional manner to their companies.

Don't play games.
I always tell my reps that they have one shot to give me the best price. I don't play games, and neither should they. Reps need to create accurate invoices, coordinate shipping and installation, and follow up when it comes time to train the staff. You should also expect them to provide expensive supplies on consignment, such as IOLs, screws or implants.

Expect the best.
I'll never forget the outstanding rep who stood by our side in the midst of opening a new multi-specialty ASC. As you'll see, she went above and beyond the call of duty by

• meeting with the surgical tech and administrator to coordinate purchases;
• spending several eight-hour days going over pricing to ensure we were satisfied;
• meeting the deadlines for getting the products before we opened and personally found and delivered products that we didn't receive;
• working with the staff to take back products we weren't happy with and to help us find substitute supplies; and
• always being available by phone, even during her vacation, one week from our opening.

Reps need to treat you like you're their only customer. If a product is on back order and you need it badly, they should find an alternate source and get it to you. If your equipment isn't working properly, they need to drop what they're doing and come to the center to troubleshoot. Good reps routinely check in to see how they can help you or the staff, yet they don't drive you crazy with phone calls and visits.

Replace bad apples
I've worked with some of the best reps in the industry. Unfortunately, I've also worked with some of the worst. You don't have to put up with a bad rep. If the relationship is beyond repair, ask the company to replace the rep. If the company values your business, it'll do it. Repeat steps one through seven.