Q&A With the Lean Dentist, Part 1

Thanks again to Dr. Sami Bahri for hosting me last week. You can read Part 1 and Part 2 of my visit report, stay tuned for Part 3 and for another Q&A. Thanks so much to Dr. Bahri for taking the time to respond to these questions:

Questions from Peter Abilla, of the Shmula blog (interesting link here about Amazon and Lean)

I'd love to learn more about the following:

1) Scheduling and Heijunka

The key point was not to track every single procedure in our business, but to stick to the 20% most frequent ones, (80/20 in frequency). We measured the takt time of those procedures. Then we spread them evenly over the schedule to create a scheduling template. The rest of the schedule was fitted around those core procedures and refined as we learned more about the next most frequent procedures.

2) Wait-Time: What is the doctor doing to reduce or eliminate this all-together?

This question is huge.

The main focus of lean management is reducing delivery (Mouth back to health) time by shortening the manufacturing (treatment) LEAD time.

As a consequence, any unnecessary time, waiting time included, is reduced through the shortening of lead time by pulling services, Just-in-time, one-patient flow etc.

If I had to pick the moments of tangible reductions in waiting time I would say:

• When we reduced setup time
• When we crossed the functional barrier between dentist and hygienist.
• When the front desk assistants accepted the practice of guiding the patients to their room as soon as they signed in.
• When we created the position of “patient care flow manager.”

3) How does the doctor balance patient care, empathy, and listening against efficiency?

If you have a copy of “The Machine That Changed the World” look on page 93. It has a diagram showing that in lean, unlike batching, you don't have to choose between quality, cost and productivity. They go hand in hand. In batch companies, quality goes down when productivity increases, and vice versa. In lean companies, both quality and productivity improve continuously.

If you judge that listening, empathy and patient care are value added, then they need to be accounted for in the appointment block.

In our case, the treatment appointment could be as long as four hours, which allows me to really focus on my patients need without being distracted by running back and forth to other patients. We are consolidating not only treatment, but also communication. Long appointment times give us plenty of time to discuss with our patients any relevant issues.

We seem to have good patient retention and tons of word-of-mouth referrals.

Thanks, Dr. Bahri. Stay tuned for more Q&A and more of my thoughts on my visit and what I saw.

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Mark Graban

Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

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