We’re coming to the end of Dr. Thrifty’s story of troubles, travails - and eventual success! He’s agreed to make a real change, and that starts with studying how things are done (or not done) now, and re-organizing for efficiency & productivity. A happier (and more profitable!) practice is just around the corner...
But before we get started, we need to figure out a trackable metric for everyone to follow, so we can really judge the impact of changing things up. We use a dentist’s production in gross dollars per hour. We’ve found it’s an easy way to translate increased efficiency into results you can really appreciate. For example, let’s say we determine your production per hour, or “PPH”, is $400 (the average recently reported by the ADA). That’s $6.67/minute, so if I can save you (conservatively) 8 minutes/hour, that amounts to over $50 of additional dentistry you can do every hour - or $1600 in a 32 hour work week!
Now, let’s find the sources of the productivity problem - and show you that nightmare example I told you about last week!
One of the first things I look at are a practice’s physical systems. Here, simplification is key! Dentists purchase many different products that essentially do the same thing, and Thrifty Dental was no different. When I arrived, I opened all 16 drawers in 7 operatories and looked in the first supply closet... then the second… then the drawers outside the operatories in sterilization. Even the old dark room served as a storage closet, the lab, then the basement (which had recently suffered a flood due to a faulty hot water tank - another time, another blog) There was prophy paste - EVERYWHERE - a total of 15 flavors! Wait a minute, I’m not done; each flavor had two grits, for a total of 30 different varieties. You’re probably thinking, “He must be a pedodontist”. Nope! Everytime the new flavor of the month came out, the sales rep (from one of the big three) cashed in! When I asked about this, the hygienists argued they would lose patients if they did not offer every flavor available. I promise you folks, I have never heard of a patient leaving a practice because ‘Key Lime Pie’ was not on the list Although you might think it’s a nice gesture to have such offerings, it costs the practice big time.
Dr. Thrifty’s current wasteful Flavo-process:
- Waste Factor #1: 15 flavors ordered in two grits; let’s say 30 items to order.
- Waste Factor #2: Ordering in bulk because, hell, it saved them $.50 per box. The average order consisted of two boxes for every flavor every month.
- Waste Factor #3: The order comes in and the boxes are kept in the basement.
- Waste Factor #4: At some point, someone would bring the flavors up from the basement and stock them in drawers in a sort-of central place. In this case, the central sterilization (hey, they had one thing going for them) has every flavor and grit stuck in every corner and crevice you could find. Since they couldn’t get it all in, whatever was left went back downstairs.
- Waste Factor #5: Hygienists would pull from the central supply to stock their rooms. ( I don’t know if you know this but hygienists, by nature, are hoarders.)
- Waste Factor #6: They would load it up and distribute across the hygiene ops.
- Waste Factor #7: Every hygiene op was different, based on the preference of the hygienist. Each of the 16 drawers were set up differently and stocked up like a hurricane was about to hit and leave them prophy paste-less for a number of months. If one op used 5 Razzmatazz that week, 25 were stocked on top of its place. (What is at the bottom??)
- Waste Factor #8: They had one big box of prophy paste with random flavors in the drawers. Some manufacturers do a good job of color coding and/or labeling the outside, so it might only take a minute or two to find the flavor you want (crossing your fingers that the flavor is in the drawer)
- But you may have to get up and go get it in the central resupply area.
- If it’s not there, it must be in the basement.
The Grand Total? It took about 8 minutes per appointment just to determine and find the “perfect” choice of prophy paste. Remember that 8 minutes I said I’d save you, Doc? Well, that was easy!
I swear, on all that is Holy, I am not exaggerating.
The inventory process needed simplification. After talking the hygienists down off the ledge, they suddenly realized how much easier things could be. “Mint? Or Fruit?” Simplification is so important that without it, standardization becomes almost impossible.
The new defined standardized system we developed looked like this:
- Only two flavors are offered to patients.
- Each hygiene op is set up identically and only stocked with one week’s worth of supplies.
- All prophy paste inventory (six weeks worth) is located in one place, taken out of the box and placed in clear containers central to the operatories visible to all.
- Operatories are stocked weekly, not daily.
- Now able to offer an entirely additional appointment per hygienist every day.
PRICELESS!!!
This is a sample of a very specific area where ‘waste’ was eliminated. I addressed this same concept throughout virtually every clinical process in the practice.
It is important to realize that Hannah and Cara had been doing the best they could with what they were given - and without clear and consistent strategies to follow. In their defense, they didn’t know any better. They didn’t know things could be easier, and frankly, neither did Dr. Thrifty. He was doing alright. He thought his schedule looked good, and he was certainly providing good dentistry. His team, although not getting along at the moment, was awesome. He wanted to do more but the inefficient processes stood in his way.
With the cooperation of everyone at Thrifty Dental, we were able to make even more significant improvements, which offered a lot of opportunities for growth; from patient care to promoting staff-growth. Together we tackled the Lean principles call the “5 S’s”:
- Sort - separate everything
- Set - simplification; determine your best in class
- Shine - keep it neat and in order
- Standardize - establish by authority, custom built template
- Sustain - must be able to replicate
Who doesn’t feel good when your house is clean, clothes put away and car washed and waxed? Why shouldn’t you feel that good every day you step foot in your practice?
Dr. Thrifty recognized he didn’t provide the tools necessary for his team and the practice to grow. An ideal team reflects what the dentist says and how actionable he/she is.
Now, every op is set up identically. Supplies are centrally located. Every product has its place and labeled in clear containers. Supply costs are reduced. No more getting up during procedures. Procedure set ups are standardized, images taken, labeled and printed. Believe it or not, everyone is communicating.
NOW THAT WE HAVE...
Accepted Change
...AND...
Empowered our team
...WE WILL...
Eliminate Waste
...SO WE CAN BEGIN TO...
Simplify
...WHICH ALLOWS US TO...
Standardize
...AND ULTIMATELY...
GROW TOGETHER
Attitudes are key! I’m not here to change attitudes. I want to help the audience think outside the box. The “it’s just the way we’ve always done it” is an excuse. No more excuses! Be confident knowing: ‘Change’ is not ‘bad’, in fact, it can actually be really ‘good’! Once ‘waste’ is eliminated or significantly reduced, more opportunities come knocking. In Dr. Thrifty’s case, growth is inevitable. The practice will likely grow to a point they hit a Capacity Wall and enter the next part of their journey…but that is a story for another time.
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