High Capacity (Quality) Dentistry P2

So, I had to have a long, serious, hard discussion with myself as to what could work and couldn’t work in Ripley, Mississippi.  So, at the time in the middle of this cosmetic craze, I’m charging $1200, $1300 for a crown, real fancy crown, and the guys down the street are charging $400.  It’s hard to compete with that because around here it’s tough.  People think a filling’s a filling, a crown’s a crown.  It’s commoditized.

So, I thought I really can’t do it for $400. Can I get anywhere close so I can compete and still make an income where I’m happy and still meet my goals?  So, starting 2005, I traveled all around the country trying to find other dentists who had been in similar situations and made it work.  I traveled to Florida to visit Vincent Monticello, Baton Rouge to visit Dr. Bob Westinman, Scott Perkinson in Houston, Texas, Roy Smith in Tyler, Texas.  I went to 19 places, and I would always visit with them.  Some places would let you come but you had to pay a little fee.  That’s fine. I didn’t care. I figured I would make it many times over, and I did.

So, I studied that, and I developed a plan where I figured if I could just completely eliminate all the real waste in the practice and systematize every process, then I should be able to steal enough of the time I was spending in a patient day and apply that to doing more dentistry.  As long as I was wise enough to market wisely, change the perception of who I was in the community from a high end hoity toity guy to a blue collar guy that just wanted to help you and do work.

So, it was a several year process. We ended up doing that by 2008.  I went to a five day week dentist producing about a $500,000 a year gross to a three day week dentist producing three times that, which is about three times the national average that they publish.  So, you got to feel pretty good about that, and I felt like the quality was still there.  We were doing a lot more dentistry, but I was three a week.  You’re not that tired at the end of the day.  You get home and everybody’s happy.

So, then, l taught that all around the country about how we did it, and the whole time I was teaching it there was something missing.  I really didn’t know what it was until this past winter.  So, let me tell you what happened. So, I’d gotten somewhat successful, published a book called “Time Genius”.  The president if Mississippi State University actually came to my dental office and talked to me 15, 20 minutes one day and said, “You know, Chris, I think some of our students could really learn from your experience, your successes, your failures, how you went from engineering and all that.”

So, I agreed to go speak to an entrepreneurship class at Mississippi State this winter, and I get down there.  It was a real bucket list.  I mean can you imagine the president of your alma mater asking you to speak to an actual class where they’re getting credit.  I mean that’s amazing.  This is actually the room where I took Psychology 101. It held a few hundred people. I mean it was just a dream come true, but we’re down there. I’m talking to them and having a great time.  The dean walks me back to my truck.

As we’re leaving the auditorium, the dean says, “Hey Chris.  Obviously you studied lean manufacturing.  It’s not surprising with your engineering background,” and I said, “Professor, they must not have gotten to that by the time I swapped courses on the engineering because I don’t know what lean manufacturing is.”  He stopped and looked funny.  He said, “Well, you just got up in front of those kids and described an exact model for making lean manufacturing work in a health care environment.”  He said, “You ought to learn more about it because that’s what you’re doing even if you use some of the wrong terminology.”

I said, “Hey.”  That’s my personality.  I went home.  I go to Amazon.com, order about 10 books, and read them cover to cover as soon as they come in.  That just opened my eyes to a new world where I always had certain things that work, but I didn’t really understand how to put them together into a blueprint like Lorne talked about earlier, the high capacity blueprint.

When I read those books on lean management and the way that Henry Ford really began the concepts of lean management 100 years ago.  After World War II, the greatest business minds in the world went over to Japan to build their economy using those principles, the Japanese took those principles and really took it to another level.  They took it to another level.  They created a culture based on lean manufacturing principles that had originally come from America.

When you read those books by the Japanese folks it is amazing the detail that they went into.  As I read it I realized there is not really one contraction in the system of how they say and do things, let’s say building automobiles, and how we do it in our practice doing teeth.  The Japanese, they always talk about continuous improvement.  Their word for that is kaizen.  I always say this when I’m doing my lecture, “If anybody out there is from Japan, raise your hand,” and if somebody raises their hand, which is rare, I say, “Look.  I’m about to butcher your language.  Please forgive me.”  So, I’m about to mispronounce a bunch of names, but if you’re not Japanese, you’re probably not going to know the difference.

So, kaizen.  That concept in of itself is a very simple concept, but that’s what we always try to do here in the dental practice.  When we started doing our system a long time ago, I got to thinking it would be nice because there’s a furniture factory in town.  Those concepts could turn out a lot of recliners.  Maybe those concepts would work in dentistry, but I would always think, “Yeah, but when we’re building a recliner, we’re building 1000 at a time of the same thing.”  It doesn’t work in dentistry.  You’re doing fillings, root canals, whatever.  The end product is far too customized.  Even tooth fillings are like snowflakes.  There are no two alike, and with root canals, it’s just impossible.

As I read those books I realized that that true end product in dentistry is not the filling.  It’s not the crown.  It’s not the root canal.  The true end product is always chair time.  That’s a pretty major concept you need to get into your head if you’re going to follow my sample.  You’re not building crowns and fillings.  You’re building chair time.

Now, the experience that the patient has in the chair may result in what type of dentistry they get.  They get a filling. That’s customer experience.  That’s not the end product.  In our practice, we’re always conscious.  We’re trying to produce as many set up rooms, ready for the patient with chair time as we can in a day, and that chair time, even though it’s an abstract concept, is our end product.  That is our Ford Model T.  That is our recliner.  That is whatever our factor might be producing. Our product is that chair time. If you understand this as we go through this a lot of this will make better sense.

So, to start this out, let me just go through and let me just share some common terminology that they would use in Japan to their clients in the dental office.  So, one of my favorites is poke-yoke.  Now, this is a term that originally meant to “full proof” something.  So, in Japan, they’re always trying to make sure that no matter what, the workers always have a system that never allows them to mess up without a bunch of safeguards coming down.

So, in a dental practice if you think about it, one of the things that whenever I interview a dentist in a seminar, ask their opinion about anything, no matter what, they’re always saying to me, “Hey, Chris.  I have trouble with my assistants.  I love my assistants.  I love my team, but they have trouble.  A lot of times, when I come into the room, they get up to go get something from the storage, to get a supply o to get something like that.”

Long ago, before I knew about lean management, we came up with what we call ten flex, and there’s a good example just on that website I gave you.  These are in my office, they’re color coded to what I show you.  In this particular procedure, orange is going to be a composite resin.  So, these are laminated posters, and we lay these down on the counter behind the dental chair 12 o’clock to where the assistant works from.

Each block represents one item that I need to complete a composite resin.  So, here, you see PDL syringe, loaded syringes, all this stuff.  So, the concept is if the assistant lays the correct template down behind the chair, and they place each of the items on the block where it says composite gun, curing light, if they lay it right there.  Each of these blocks fits, by the way, the item you’re laying on there.  Then, after they’re through putting the supplies behind the patient, they look at this template. If every block is covered, then the procedure is ready to go.  There’s no supply missing.  That’s the whole concept of full proofing a room setup.

Here’s a good one, the concept of kanban. Now, in a furniture factory or a car plant, a kanban, the word actually means single card, but above everything else, there might be a giant illustrator.  There might be a big TV screen, and it’s going to keep statistics on it.  It’s going to let them know where they’re at, how their doing, how they’re proceeding throughout the day.  There’s a Toyota plant 20 miles from Ripley, Mississippi now, and a lot of these concepts is right there for me to look at.

So, in our office, we try to figure out how we can put something somewhere in the office that keeps everyone on target and let’s everyone know how the day’s going, what needs to be done next so the doctor can look it at a glance and know where they need to go to next because, in my opinion, the doctor should never be rushed with the patient.  The patient comes here to get treatment from us.  No matter how much dentistry you’re doing, you owe it to that patient to be calm, collected, and focused on them when you’re seeing them.

I will not condone somebody that rushes through the day and tries to be fast for the sake of being fast.  No way. You’ve got to be focused.  You’ve got to do the patient right, and you’ve got to do good dentistry.   This kanban board, we call ours the route board, allows us to do this on our practice, and this board is kept in a central location.  It’s in our sterilization room now.  It used to be in our hallway.  Now it’s in our sterilization room now.  We actually have a closer look at a TV feed that shoots it around the office all the time. So, I’m never more than two steps away from seeing everything that goes on in the office.

Obviously, you could do a whole day’s lecture on this thing.  We can’t get into a lot of detail, but the whole concept is there is a board somewhere in the office that everyone can look at.  Don’t tell me I’ve got software, I’ve got live systems because I’ve done it all.  I’ve done it all in combination, but this board, broadcasted around the office, will beat any other hands down if it’s utilized properly.  That’s just like anything around here.  You have to utilize it properly.

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