Q&A With the Lean Dentist, Part 2


Here is a follow up to Part 1 of the recent Q&A I've facilitated with our friend, Dr. Bahri. Thanks to the blog reader (who works for a non-Dental, non-Medical company) who emailed me these questions. I always love hearing from my readers and Podcast listeners, thanks for writing.

1) What is a “flow manager”? I seem to remember in your podcast that he created a couple of “flow manager” positions. What exactly do these people do? I have thought about creating a “flow manager” position in my office who would primarily be responsible for “filling in the gaps” wherever they exist and helping to move things and update tracking reports, but I am getting pushback from people who think it would be more efficient for the workers in these respective areas to do the work themselves.

The “flow manager” position was created late in the process, when we already had flow in place. We needed to know where to go next after we were done treating a patient. The full title is “Patient Care Flow Manager”. The underlying meaning is to have a person focused on the non-stop care throughout the clinical part of the office. In a different environment her attention would be focused on the product, whatever it is, and making sure the work on that product is constantly advancing. These are her main functions in our practice:

  • Secures JIT service for the next step through a “Service Kanban”
  • Enters the line when needed
  • Continually eliminates waste

I have no experience in creating the position of “Flow manager” before establishing Flow. I don't see how it would work, but again, no idea is good or bad until we have tried it.

2) Training — I suspect that Dr. Bahri was originally the one who came up with all the ideas. However, I also suspect that is no longer the case. How did he teach people to see things differently? Did he take them to an LEI training seminar, require them to read books, take them to visit other lean places? Or, was it simply a matter of Dr. Bahri leading the way and the rest of the team eventually learning from his example?

All training was made in-house. In fact, we have learned it together. It is true that, for the first years, I was doing all the research work, but I have always shared the relevant ideas with my staff. We put our heads together to figure out what the different principles meant for us. Principles like flow, level, pull, Kaizen, the different wastes etc. I believe in the one-piece flow principle for everything, including training. I have trained one person at a time, in one procedure at a time. Once it was successful and others asked to be trained in it we added them to the group (pull system in training). The idea of training everyone at the same time would be like applying “Batch Thinking” to the “Lean Thinking” implementation process.

3) Replication — Are there any other dentists who have tried to replicate Dr. Bahri's methods? If yes, how has it gone? If no, why not?

I don't know of anyone applying my methods. For a long time, up until lean people like Jerry Bussell, Jim Womack and John Shook told me that I was doing something special, I thought what I was doing was very normal. So I never prepared to share it with my colleagues. Today I have a little focus group trying to refine the message and make clear and appealing to the dental community.

Thanks again to Dr. Bahri for sharing his time and his responses with all of us. For more, click on the “Lean Dentist” link at the bottom of this post.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. 1. From the early 90s till 2005 I was really by myself. I was lucky to always find staff members sharing my excitement in learning new ways to improve work; they all helped me in the implementation. But no one from outside the office – if that’s what you mean.

    2. Around the end of 2005, Jerry Bussell from Medtronic, (he is now Chairman of the Board of Governors at the Shingo Prize) found out that we were applying lean to the dental office. He told Jim Womack and John Shook on me. Then Jim came, and later John came, to see for themselves. Their interest in what we are doing gave a big thrust to our efforts. It confirmed to the staff that what I was advocating had some real value. You could say that they helped the implementation efforts, just by confirming its validity to my team.

    3. In 2006, a benchmark visit to Medtronic helped a lot. Everyone came back with great ideas that we implemented. Also Jerry’s style of managing from the Gemba, not from his office, encouraged both “Patient Care Flow Managers” to leave their offices and stay close to the patient.

  2. From Dr. Bahri:

    I’ll be happy to answer that question.

    Employee retention is actually very easy in my office. Some people have been with us for 16 years or more. To be specific, we look at employment at two levels. The first level is what I call the “core staff,” those who decided that they like our culture and have been with us for a long time. We do everything to keep them. The second level comprises the new employees who are testing the culture. If we find a compatible member in the second category, we do everything we can to add them to the core.

    Usually, within a week or two, a new employee would either like our culture and stay for a long time, or feel repelled by it and leave. Those who stay get infected with the “Lean virus”. It becomes almost unthinkable for them to work in an environment where they can see waste and not eliminate it. They won’t work if their opinion is not heard. Since my office has no competition in the Lean and “respect for people” environment, It is usual for my people to come back after they’ve found that the grass is actually not greener on the other side. They also come back after long maternity leaves, after a spouse’s job transfer or any other reasons that force them to stop working for a while. Even if they moved to another office, they would still come and help us when a seasonal demand exceeds our capacity. We like to think of our office as their professional home, they can go wherever they please, and come back to Bahri Dental Group. It is not officially employment for life, but it sure is very close in spirit.

    I hope I answered your question to your satisfaction.


    Sami Bahri, DDS


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