Another that I like is genchi genbutsu.   Now, this term literally means “boots on the ground”.  So, I’ve changed my position, and I feel like we’re right more than we were.  I used to say that I wanted the dentist to come into the office and they’ve got all their systems set up and never ever have to worry again about managing anyone.  I think I was wrong about that, and I’ll admit it now because periodically, even the higher up Japanese CEOs do this, periodically, they will get their feet on the ground in a Japanese factory and get in there and fix a problem. You cannot completely, 100% fix a problem and always fix everything.

Obviously, you can’t always be there and fix a fire, but it is a very, very important thing that we teach that you should not be putting out fires daily.  You should always be able to plug in and do your dentistry without worrying about all the little micro things in the office, but certainly, occasionally, maybe once a month, go in there to see what’s going on.  If there’s a problem, fix it the best you can.  So, everyone stays on target knowing what you want.  That’s the concept that you really need to consider doing.  So, the point I’m trying to make here is yes, it’s good to do that occasionally once or twice a month.  No, it’s very, very bad to try to get in and try to micromanage everything in a dental office.  If you came to my practice, you would see I personally do very little except dentistry on Mondays, Tuesdays, Wednesdays.

Alright here’s a good one, nekku.  Now, nekku means “a blockade”, a blockage, a road block, a narrowing.  Now, where in your practice can you find a blockade?  We’re going to go through in a minute a flow sheet. A term that I came up with which I’m sure is not the right terminology for management, but a nekku in our practice had always been the diagnosis because who read Dental Town this month or last month?

When I get my Dental Town magazine, I immediately read the Howard Speaks section.  Howard Farran is a good friend of mine.  Besides being a friend, he’s like a hero of mine.  I always love the guy, and I agree with him a lot.  He said 20% or 30% is what the average US dentist has for case acceptance.  Now, I did not know that. I have always been looking for this magical number is for what the average American dentist has for case acceptance percentage because we’ve measured ours for 10 years.  I’m proud of ours.  We’re up about 75% of case acceptance.

Long ago, some management practice person said that 76% was what we should out for, and I’ve always shoot out for that.  Ours has always been a little below that, but it’s still good.  According to Howard, it’s great, but that had always been one of our blockages.  How could we get more treatments scheduled?  So, we came up with a very simple three phase diagnosis that I’m going to talk to you about later to solve this blockage.  Be serious and think about yourself.  Spending a day and a half thinking would be a very profitable exercise for everyone on this call, just think about, “Where in my practice could things be better?”  Sit down, draw out a blueprint, draw a process map, and make it better.

Now, I always have people guess what this word means.  So, we get all kinds of answers.  People always say, “Stop watch.  Time.” Those things are close, but muda actually is a Japanese word for “waste”.  We’re going to talk about the seven deadly dental wastes that I’ve interpreted from the seven deadly wastes of just plain, old Japanese manufacturing, but time, in my opinion, is the biggest waste in a dental office.  So, that’s why I put the little stopwatch here.

The next one.  This is a good one, muri.  When I speak or when I go into a dental office, initially, the dental staff bristles up.  Their hair stands up on the back of their neck.  They absolutely hate to see me coming because they think that I’m about to give them a whole bunch of stuff to do, but if you could just be enlightened enough to be at our practice or read some of the testimonials from the people that we’ve helped, we do give people stuff to help them.  In the end, the end result is a lot less work.  So, this work actually means “overburdening”.

This is something that I’m constantly vigilant to avoid because you don’t want to charge in and give the staff or the team members a bunch of extra stuff to do.  They’ll balk on you.  They’ll never do it.  It’ll never work out.  So, you always want to be conscious to add a little bit, to get it working good, and then add a little bit more.  If you’re headed towards a goal, Rome wasn’t built in a day.

The point is don’t just throw a bunch of change on your team or your staff overnight.  Plan it out and make it go as smooth and as simply as possible.  Never overburden them.  If you’re getting in there and you’re doing too much in your practice, if you’re staff’s making you do things that they should be doing, they’re overburdening you.  There has to be a balance, a balance between the load the team is carrying and the load the doctor is carrying.  Okay?  We’ll talk about that again in a minute.

Here’s a good one, jasuto in taimu.  I’ll tell you what it means.  It’s very simple, “just in time”.  Just in time is very important when you’re building a car because you don’t want inventory stacking up all over the factory.  You want the bolts to be continually coming to the person putting the tires on.  Always just have a few extra, but not a bunch.  So, we’ve always done this seriously.  In ordering our system, we’ve run out of stuff right before it’s time to order again, run out before items actually come in.  So, there’s actually a little bit of an overlap but not much.

We had an assistant one time who used to order for me, and she would get these show specials and monthly specials.  It took me nine years to use up all the number 4 round burs that she bought back in 2001, just as an example, but as we go throughout the day, we would like for the dental chairs to become available, ready for patients just as soon as a patient is available for it because you don’t want to be in a situation where you’re all blocked up and people are waiting, getting mad.  You want a nice, natural flow of things where chairs are being constantly turned over and ready to be sterilized, and there’s just a nice flow in the office and not just this big flurry and nothing to do, flurry and nothing to do.  That’s what you want to avoid.  So, just in time is a concept we want to have.

Heijun ka, this is scheduling.  Now, scheduling is very important.  It’s a skill.  It’s an art. It’s all those things put together.  You need a good person to be a good scheduler.  You also have to give them the tools and the ability.  I don’t know if there’s any scheduler in the world who can schedule appropriately if you’re not consistent with the amount of time it takes you to do a procedure or if you give them absolutely no indication on how long it’s supposed to take.

How are they supposed to know?  Are they supposed to look at a set of procedures that you’re supposed to do for a patient and just get it right on how long it takes?  No, that’s crazy, right?  You need to have a system to give them the information they need to make their scheduling more effective, and if they can be more effective, it makes everyone happier.

The clinical staff will not get stressed out.  They will not get overburdened.  They will be happier.  If they’re happier, the front office people would be more confident for fitting in the procedure so you have higher production in a day.  You can’t have higher production if you can’t do more procedures unless you raise your prices sky high, but is that really going to work in this economy?  I don’t think so.

So, you have to go give your scheduler the tools they need to do a good job.  Then, expect them to schedule appropriately.  Do you think some people, right here, this schedule looks crazy busy?  Other people might be looking at this and saying, “Boy, Dr. Griffin.  He’s not working hard at all.” I don’t know.  This is a pretty reasonably good example of an average day at my practice.

Okay, now, like I said, we’re going to talk about the seven deadly dental wastes.  I am pretty much taking it interpretatively from the seven deadly wastes found in manufacturing.  So, let’s get into it.  Number one, perishable inventory.  We talked about it earlier.  You don’t want to be one of those people that orders too much stuff from your supplier.  What else is important in a dental practice?  Is time important in a dental practice? Absolutely, time’s important in a dental practice.  So, if you think of time, chair time is an important inventory.  Every second of every day that a dental chair sits without a patient in it, you have lost inventory. It is gone away, never to come again.  There’s nothing you can do about it.

You cannot stack time in a warehouse, and you’ll get it when you need it.  If you’re working and your overhead’s running and you have a dental chair sitting there needing a patient or needing a doctor or needing an assistant or hygienist or someone to man that patient and it does not get used, that is lost inventory.  You cannot get that back.  So, all the systems we’re going to talk about, using a color-coded template and everything else, those are designed so you lose as little of that special inventory as much as possible.

Chair side, a little bit more clinical, wasted motion.  Now, a good example here.  Here is a picture of me doing a root canal.  You can see in the background, you got me holding a hand held wireless endo hand piece.  So, I little part in one of my lecture where I explain the proper way to hand endo.  So, we have a mannequin here in the office, and we have doctors that come here sometimes.  We have them sit down with the mannequin, and they drill.  We watch them. I’ll tell you, some dentists will sit down, and they’re confident.  They just boast through those mannequin teeth, and they’re pretty fast.

The other people are not all fast, and they could take a procedure that should take five or ten minutes, like drilling a crown on a mannequin that’s obviously not going to yell and scream if you hit a nerve.  They do that, and they take 30 minutes doing it.  Now, as you watch, we film these things and break it down like John [35:14] on TV.

So, what do you think happens?  The bur is on the tooth a reasonably close amount of time when the guy is drilling 5 minutes and when the guy is drilling 20 minutes.  What’s the difference?  The guy that drills for 20 minutes, he’s drilling about 3 or 4 seconds, stopping, look at the mirror to see what he did is perfect, putting the hand piece down, drilling for 3 or 4 seconds, looking, putting the hand piece down, picking it back up.  That’s what he does or she does.  That’s what they do.  That’s why it takes so long.  We have to coach it out of them.  When they get home, we don’t know if they still do it or not, but, at least, when they’re here we try to coach it out of them, get them where they need to be.