Lean Means You Spend Less Time at the Dentist

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Florida Times-Union (Jacksonville)

June 20, 2007

Sami Bahri's waiting room doesn't look much different from those you might see at other dental practices?same magazines, same chairs, same reminders to brush and floss.

The difference is what you don't see. People.

At the Bahri Dental Group, patients show up and are shown to their dental chair within minutes, rather than hanging out reading gingivitis posters.

You can call it just-in-time dentistry ... No, really, you can; that's not a joke. The behind-the-scenes processes that enable Bahri's office to move patients through quickly and smoothly draw upon a series of principles, including just-in-time delivery, derived from Japanese auto manufacturer Toyota.

Bahri has taken these principles, known as lean manufacturing, and applied them to his practice. Lean is both a way of thinking and a set of processes, all designed to cut out wasted time and effort and make the business operation more efficient.

For the dental office, this means small things?like arranging sterilization areas in a way that minimizes steps?as well as large things. One of the biggest differences at Bahri's office, for example, is that patients don't move from room to room or have to deal with multiple appointments even when they have multiple issues that need to be addressed.

Need a cleaning, an exam and a cavity filled? Get it all done in one go, rather than coming back another day.

For his efforts, earlier this year the Lebanon-born dentist received the Shingo Prize, a national award given companies and researchers who use and studies lean principals. Bahri has been using lean techniques for around a decade, after running through a buffet of management philosophies.

Although his patients' visits are shorter, Bahri said, the time spent with each is about the same.

The difference is that the patient is supposed to spend as little time as possible being made to do things he or she doesn't want to do, particularly things that don't lead to accomplishment: Sitting around the waiting room, waiting for a hygienist to show up, coming back for another appointment when a problem is found on the first one.

"When the patient gets in the chair, we don't want to waste any time," Bahri said. "I look at it from the patient point of view."

That efficiency has even helped change patient behavior. Knowing that they won't be left sitting around, Bahri said, patients are more likely to show up on time.

The office is entirely arranged around lean principles scrawled on a board in the breakroom and discussed each morning in staff meetings.

The changes include tangible ones, like hiring a flow coordinator who makes sure there is no wasted time while dealing with patients (each one with his or her own flowchart), as well as more mental shifts: Employees are encouraged to develop their own ideas for how to be more efficient, for example.

"They have some of the most beautiful ideas," the dentist said. "I beg them for their opinions."

The biggest suggestion that Bahri is now looking to put into place is to combine the orthodontics area with the rest of the practice, just as caps and cleanings are now done in one place. But other changes are also welcomed, he said, even minor ones, as long as they lead to greater efficiency.

"There's continuous improvement through big changes and small changes," he said. "It never ends."

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