But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Wednesday, October 5, 2011

The Lean dentist

The next speaker I am hearing at the "Made Lean in America" conference is Sami Bahri, DDS, author of Follow the Learner: The Role of a Leader in Creating a Lean Culture.  The book describes how this organization, the Bahri Dental Group, transformed its work and thinking from a traditional batch-and-queue approach to one focused directly on the needs of the patient, not on the needs of the practitioners.

Sami related how his practice in Jacksonville, Florida was growing unsustainably.  His solution to complexity was to "hire more people," but he soon realized this was not the answer.  "I wanted to get rid of the problem.  I needed to find a theory.   With a theory, you can make quick decisions."  He then became aware of the Lean philosophy and the work of Jim Womack and others.  Reading a number of books, he figured out how to apply Lean manufacturing ideas to his practice.

Sami summarized that Lean was an evolution over time of our collective thinking.  We started as craftsmen; then moved to the division of labor; but then, with more complex processes, we had quality problems; then time and motion studies of people led to improvement of functions; and then we learned to follow the product to improve efficiency and improving quality.

Sami said, "I went back and started learning how Toyota did it.  How did Ohno start?  'The TPS started when I challenged the system.' "

Sami noted, "It took him five years to produce a high quality car.  It took me nine years in our practice."

His conclusion after all this time:  "The most important ingredient is people.  Are they learning every day?  If you want them to learn and sustain the system, you need your people."

Speaking of his practice, he noted, "Set-ups stand in the way of one piece flow.  We eliminated these."

Sami defining "leveling" as balancing load and capacity.  The idea was to distribute procedures, according to TAKT time, evenly throughout the schedule.

He had to define "flow" in dentistry.  This resulted in a system of one appointment to see all providers.  The end was continuous treatment, with no delay between providers (just-in-time treatment).

His goal was that the patient's stay time would be equal to the treatment time, eliminating waits, optimizing use of the patient's time but also the providers' time.

The treatment the patient receives changes during the appointment, but the patient location stays the same.  Providers move to where they are needed.  Crossing the functional barriers was key.  The hygienists, whose lives improved dramatically under this approach, ultimately said, "Please don't give me my own room.  I'll go to whichever room the patient is located."

Sami reported on patient satisfaction surveys, showing a remarkable uptick in their views about his office and his staff.

All in all, this was a marvelous presentation by a thoughtful entrepreneur applying the theories of Lean to a new setting.

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