A Visit with the "Lean Dentist", Part 1

Last Thursday, I had such an enjoyable visit to Dr. Sami Bahri’s
office. I was very impressed with the “Lean spirit” of Dr. Bahri
and his employees. The culture there is pretty impressive. 
What does this have to do with manufacturing?  If you read on,
I think you’ll be impressed with their Lean culture and their Lean
management system — aspects of Lean that have been transferrable
from manufacturing to dentistry…. and these lessons and insights
can be transferred back to manufacturing, I believe.  Here’s a
chance to challenge your Lean thinking — are you doing as well as
this dentist in the way you lead your people through Lean?

Looking through his office, Lean “toolheads,” if you will, would
possibly be disappointed. Is it a “Lean dental office?” they might
ask, walking around looking for 5S and kanban cards. As an aside,
here’s a great
paper by John Seddon, about that “toolhead” term and the
dangers associated with being fixated on Lean tools. Dr. Bahri and
the people in his office are NOT “toolheads” — that’s a good
thing.

The office is focused on solving
problems and preventing problems. Rather than implementing
tools, I could tell the discussion is focused on making things
better for the patient (reducing delays and inconvenience) and
making work easier for the employees at all levels. That was
impressive. I talked with many employees and they all talked about
the same mindset, which was impressive. There is a drive to do
things better. The employees (including Dr. Bahri) do not seem
fixated on the press and the awards they have received.

“We’re not perfect,
but it’s better than before. And we keep working at getting
better.”

That seemed to be the mantra, everyone seemed to make that same
comment. Continuous improvement, involving all employees, and
eliminating waste. They have a very advanced Lean culture, compared
to almost any workplace I have seen or been a part of.

Talking to Dr. Bahri in his personal office, I saw many books that
I also have on my bookshelves. We’re both heavy readers. You would
recognize many of the books, I’m sure. What is impressive to me is
that Dr. Bahri (as you heard about in his
Podcast) has gone to all of the original source texts –

Ohno,

Shingo,

Deming, and
he has distilled it to what matters for his dental practice
business. He didn’t have anyone to copy, at least another dentist,
so they had to figure it out for themselves.

“We start with the
patient, not with the tools,” a front-desk employee
said.

I also saw the break room, which also doubles as the daily team
meeting space. Just looking at the whiteboard, there’s very neat
evidence of the discussions that happen every day — part training,
part problem solving. It might be the only dentist office breakroom
where the whiteboard has scribbles about:

• Process maps
• The types
  of waste
• The
  cost/price/profit equation (how price is set by the market, you
  increase profitability by reducing costs)
• Taguchi loss
  function

I saw examples of the Training
Within Industry methodology, including a front desk assistant
who showed me classic
Job Breakdown Sheets that employees had been creating (and
updating!). They focused on “what was important to document” rather
than just documenting for the sake of documenting, which was nice
to see.

Here’s something that you can’t teach, necessarily, and it’s hard
to copy — you can tell Dr. Bahri cares about his employees very
much. “Explaining why” is part of the culture, it’s something they
work at (although there’s still room for improvement, which Dr.
Bahri recognized when I pointed out a “warning” sign that didn’t
explain why). That’s a key part of the “respect for people”
principle.

Dr. Bahri and his office still have a lot of opportunities ahead,
both in terms of implementing Lean methods and for their business,
in general. The Lean improvements have freed up capacity that needs
to be filled. So, if you know anyone who wants a new dentist in
Jacksonville, Dr. Bahri’s office can take them on. There is a
strong commitment to making sure that freed up capacity won’t
translate into laid off employees.

In Part 2, I’ll come back to the Lean tools that I saw in place and
I’ll also have some final comments about my visit.

Thanks again to Dr. Bahri and his team for letting me spend time in
their “gemba.”