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My Visit with the Lean Dentist, Part 3

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Click here for Part 1 and Part 2 of the series of posts about my visit to Dr. Sami Bahri, the “World's First Lean Dentist.”

In Part 2, I talked about how the Lean “tool heads” might be disappointed, and we talked about aspects of a Lean Culture. But now, here's something for the “tool heads” — yes, tools are important, but let's not put them first. Lean is a combination of tools, management system, and philosophy. Here are the tools I did see in place:

  • U-shaped cells: sterilization areas are set up in U-shaped flows, where tools flow back to where they came from (as opposed to the old linear layout)
  • Materials: inventory levels have been right-sized for each patient area, which bins that were created specifically for their use. Inventory layout appears to be pretty standardized across the stations. Inventory is pulled from a distributor using a re-order point system and a simple bar-code scanner (as opposed to kanban cards).
  • Pull: I did see the famous “kanban cards” for pulling resources to the patient, whether it is a dentist or a hygenist. There were times I was talking with Dr. Bahri and there came the kanban card. He had lead time (as indicated on the card), so we could finish our thought and he didn't have to immediately run.
  • Visual management: As you could see in the picture I posted the other day, each station has a simple “andon” card. Green means everything is OK and there are other colors to indicate what type of assistance might be needed. The kanban cards are also color coded to indicate who they are far (this is a recent kaizen improvement).
  • Level loading: visual schedules are posted, an attempt is made to level load the cleanings throughout the day.

With the visual controls, one person who is monitoring those, among other duties, is the “Flow Manager,” the position that Dr. Bahri described in the Podcast. The flow manager is a unique position. Their job is to manage the flow — who is occupied with what, when will they be done, who is next, etc? Basically, the flow manager gets to tell Dr. Bahri (and others) where to go — they just have to find him first!! That was made harder by him touring me around the office.

I asked the flow manager how she knows when to give the signal, to anticipate when things are done. In one example, she said that you can hear the hygenist flossing and that's one indicator, especially when they are working in a standardized sequence and you know how far along they are. “You can hear flossing?” I asked. “Sure, if you're close enough.” The value of an open workspace and having a flow manager in “the gemba!”

It's very neat to see. I wish I could have spent time shadowing the flow manager for a while, time got short, there was so much to see and to talk about. The office definitely has opportunities for improvement. They recognize that, much the same way Toyota would. Dr. Bahri and his staff are very proud of what they have accomplished, but I would guess they wouldn't put themselves at a “Toyota level” of achievement.

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To try to summarize, I was very impressed with the culture that was very strong in the areas that Jon Miller wrote about as leadership concepts of Toyota and Gary Convis:

  • Total commitment. Definitely a strong commitment to improvement and to Lean, but not just Lean for Lean's sake. This commitment comes from the top (Dr. Bahri) but seems shared throughout the organization.

  • Full commitment to the “customer-first” philosophy. They put the patient first.

  • No artificial barriers between departments. I saw a lot of good teamwork and cooperation, the breaking down of barriers between “ront desk and dental assistants (making sure people have the proper training to help).

  • Aggressively seek to solve problems. Strong problem solving and kaizen focus.

  • Human development. Lean is about growing people, lots of time spend on development and improvement, it seems.

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  • Management must go to gemba. A dentist is unique — Dr. Bahri is the CEO and he is also doing Value Added work at the gemba. That creates some unique leadership opportunities (and challenges, I'm sure).

You can also check out the Q&A's with Dr. Bahri, Part 1 and Part 2.

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Mark Graban is an internationally-recognized consultant, author, and speaker who has worked in healthcare, manufacturing, and startups. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent book is an anthology titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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  1. […] Part 3, I’ll come back to the Lean tools that I saw in place and I’ll also have some final […]

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