Fusion of Japanese Efficiency and American Private Practice – Season 1 Episode 16

The Dr. Chris Griffin Show – Season 1 Episode 16

“If everyone is moving together, then success takes care of itself.” Now who said that?

Welcome to the Dr. Chris Griffin Show. Your resource for leveraging systems and technology to easier workload, increase productivity and provide you with the time off you deserve to live the life of your dreams. It’s time to practice productivity in the passionate pursuit of a better life with your host, Dr. Chris Griffin. The Dr. is in.

So you may have actually heard that quote. That is from a very, very famous person in American history, Mr. Henry Ford. You all know him? He’s the founder of Ford Motor Company but Henry Ford was also maybe more importantly the unwitting founder a concept called Lean Management. Now Lean Management is something that was adopted in post World War II, Japan. And help build some of the largest companies that the world now knows into that juggernaut that they are. And all this really came from these strategies and concepts that Henry Ford developed’ really going way back. I guess some people say the Father of Lean Management was actually Eli Whitney but moving forward, Henry Ford really make that happen with his assembly line for his cars.

And then his concepts were taken off over the post towards Japan and you know, they just went nuts with it. They actually developed this Lean Management theory into something amazing and it turned out into you know, the Toyota production system. That’s basically based completely on concepts Henry Ford came up with. So I thought it was certainly appropriate that they were used to quote Henry Ford today. Now today, we’re going to dive in to this Lean Management theory as we go back to the lecture I did in Oklahoma City and we’re going to be talking about all kinds of amazing things that I have applied in to dentistry from these Lean Management concepts like color coding, visual learning, Kanban boards and just on and on. So I’m really excited today, it’s absolutely something. It’s true to my heart in dentistry, it’s what I really think helps everyday dentists really make a difference and getting more dentistry done; it helps everybody, patients, doctors, team, everybody. So let’s go ahead and let’s jump back to the lecture and let’s hear all about the Lean Manufacturing theory.

The fun parts are the rewards, and I’ll tell you what I like to do, I like to like combine work and fun. So like if we’re doing really well, I will take my staff on a sea trip with me or something like that. Be sure you’re acknowledging things every time somebody does something really well. I’ll show you some pictures. So 2005 was the year that we converted from the cosmetic practice to the higher volume practice and you know, we had a great year; I mean a blowout year. I think we went that year from 600,000 to 850,000 or something like that, in 2005. And so I sent everybody on a cruise, right? I figured, “Heck you guys worked your butts off, we’ve accomplished something, there you go.” You’re you know, I sent them to Cozumel. This year, you know everybody had quit, we had a new team, I had so many new people that it seems simple. But we use Dentrix right? Who uses Dentrix? In here, a lot of people.

You know if you use Dentrix forever, it’s not that hard but if you hire 3 or 4 new people, it’s not the easiest thing in the world for everybody to pick up right? So this year, I took everybody to the Dentrix training down in Orlando and then we spent a whole day in Universal the next day. Now let me tell you something, this was the staff, there was a lot of bickering going on between these new girls that I hired. After we took this trip to Universal, it has been smooth sailing. That was last November and everybody is getting along. It’s crazy, I mean it was so bad that I had staff coming to me they’re you know, Lupita she’s like “I don’t know what we’re going to do, you know, this one hates that one and that one hates that one. And I don’t know.” You know, anyway, we took this trip to Universal, it fixed it. So you know, I think that there’s always ways that you can be creative and figure out you know, ways to make things better between your staff.

Okay, so how do we help them be the best staff they can be? So we put them in a right environment and one of the things that…I was telling somebody this morning that there’s a Toyota plant 22 miles from my house; they just put in 7 years ago. And you know, it’s a big deal. It didn’t really helped my practice that much, I thought it would. But what it did do is sort of…I have a lot of patients now that go work at Toyota and boy, Toyota. They mean business with their management system. So they mean business with their, the way things work, the way their lines are, they are serious. And one of the things that Toyota does that I picked up and put it into my practice, and it made a huge difference there, too. It’s like things are different colors. This particular line, if you go into a plant, any of you ever been in a Toyota plant? So you haven’t have like different color stuff like the line that suppose to well this particular part on the body of the car is orange? They’ll have a line that’s green that’s doing something totally different. They have a line that’s yellow, they have…yes, everything’s color coded.

And so I thought, okay, if Toyota thinks it’s important enough to make things color coded to help their staff, maybe it would help my staff. And then I thought, how does this apply…how does this apply to a dental office? Well, you know, if Toyota thinks it will help things to move faster, maybe it would help me. Because sometimes when I go into an operatory and sit down to work, have any of you guys ever experience this? You go in, you sit down and it’s just not really ready for you to be in there yet, you know. You’re ready to do the work, you’re ready to pick up the high speed hand piece and start drilling, but everything’s not in there. And so how can you efficiently start working if you know that you’re just going to have to stop and somebody’s going to get some more stuff in there. So I said, Okay, well that seems like…maybe there’s a way that we could use that concept of color coding and Toyota would probably say visual learning and stop all of these forever. A lot of this goes back to…all the way back to Henry Ford and Lean Management.

Any of you guys know about Lean Management? Well 3 or 4 years ago, I was actually asked to come speak to the Engineering College Entrepreneurial Program in Mississippi State. And so, by the way that’s really cool, so I get to go back and speak to this class of 200 kids who are in an entrepreneurial class but they were all Engineers, about how that I was able to do a dental office that produced so much per hour or more than the other dentists in the area. So I get up there and this is awesome because this is the same exact classroom where I took Psychology 101 in Western Sib so I thought that was awesome. Gave the speech, the kids were awesome; they were asking all kinds of questions you know. Here’s the dean that asked me to come Dean Martin up there in the black sweater. You know, this guy here is probably a millionaire by now. He had all this entrepreneurial ideas; the other guy, the president of the organization.

So anyway, we do all this and so it’s over and Dean Martin is walking me out to my car and Dean Martin says, “So Chris, it’s amazing how you incorporated Lean Management into all these dental office systems.” And I said, “Dean Martin, I don’t know what you’re talking about because I’ve never heard that term before.” And he said, “Oh, that makes sense.” I said, “What do you mean?” He said, “Well the things you were saying, completely agreed with the Lean Management theory but the terminology you were using were all screwed up.” And I said, “Well that makes sense, because I made it all up myself. So there’s no doubt that I’m sure it was.” I said, “I hope I didn’t confuse the kids in there.” So anyway, the Lean Management System says, that you always must work towards the Kaizen which is Continuous Improvement. So everything you do from this day forward should move you toward your ultimate goal. And Toyota’s crazy man, they have like 100 year goals and stuff and that’s just how they do it.

So there’s also a concept in Lean Management called Poka-yoke. I’m sure I mispronounce it. Any of you guys speak Japanese? No, excellent. Well I’m just pronouncing the heck out of this. But, so here’s an example of how that color coding could help your staff and help you solve the problem of walking into an operatory and not have everything perfectly set up for you. In everybody’s office, you have probably got a countertop. Everybody got a countertop? You got a countertop? Okay, alright, good. So in my particular office, my countertops that I like to put my equipment on or my supplies is at 12 o’clock behind the chair. Doesn’t work everywhere but 12 o’clock is where mine are. So this is what the example shows. And so what we decided to do was, like, if this is the countertop, it sits have of this table right here. We took and measured it, and we figured out what is the exact perfect way that this would need to be set up so that if I walk into the room, I’m exactly ready to get to work with no stops. Okay?

And so we would set the room up perfect. I would come in, I would sit down and we’d do like mock procedures and we’d be like, “Oops, sorry. You forgot so and so…” “Oh, yeah yeah yeah.” So we worked in and we got it just exactly perfect. I signed off, “yes it’s perfect”. The clinical team leader looks at it, “yes it’s perfect”. Okay, so we would put down. I mean this is just like old school as it gets but we would take, I took like a poster board and I cut it out like exactly the right size of the countertop, right? Put all the stuff on there that I would need for the procedure. You know, everything; instruments, syringes, whatever, bur blocks, everything. Set it down there and then take a pencil, trace around it, pick it up and write down what it was. Right? So then, once we had that, we pretty much just sent it to a graphic designer and they made an exact size replica of our poster board on PDF, print it out, color coded every single item.

So we made…and by the way, we make these templates for every procedure and so the gauze is always purple on every one of our templates. The syringes they’re always pink on every template because that’s always gray and they’re always in the same place. Although for each procedure, as you can imagine, there’s different things, right? So we have an extraction template. We have a segmentation template. This is a composite resin template, we have a crown template, we have a root canal template. But everyone’s, every…the background color’s different for every procedure. If there is a similar item, like the cassette always goes front left. It’s always gray. So that helps your staff know, they know where everything goes. So they don’t have to try to remember where he wants the cassette on this procedure versus this procedure, where they want the gauze on this versus this. And so this goes through.

The cool thing about that is, it really helps everybody out because you put this down so when we’re setting the room up, they’ll put this template down and I’ve got better pictures in a minute. They’ll put the template down, they’ll put all the supplies on it. If they forgot something, it’s staring you right in the face. If you forgot the bond, there’s a black square there that says “bond” which is telling you “Oh I forgot the bond”. So before we tell the doctors it’s time for him to come in here or her, “Let’s go get the bond and put in on there.” And once everything’s covered you know, okay it’s perfect. I feel good about it. Now we can go tell the doctor, right? Bur blocks, I went all out with this Toyota thing, man. We decided…because I’ve been to all these courses. Every course you go to there’s Dr. so and so’s bur block, Dr. so and so’s bur block. I said, “Man forget this. I just need to figure out a bur block that I can use for every single procedure.

And so I took all these burs that I used and I’ve got it down to, 15 burs. Okay? This is the 15 burs that I use for every single procedure in the office. And then, we even color coded this by taking the autoclavable tape, cut in squares and put it over the block. Punch in a hole in it and so you know what happens if you’re drilling on a person and the bur gets dull? And if you’re like mean, you take it off and you toss it over your shoulders. You say “Give me another 18 diamond…” or whatever. Well a lot of times, a staff…whose staff that might turn a room over? You? Okay. So are there times you come in here and all the burs that were in the room to begin with are not there when you leave, right? Okay. So then a lot of times, what would happen is, this bur block goes to the sterilization but because you’re so busy, this bur, this number 18 diamond never gets put back in there. It gets put in the autoclave, maybe it’s put in the cassette, gets back to the room again, the doctor gets ready for the 18 diamond, “Whoa, where’s the 18 diamonds?” It ain’t there, now there’s a pause. You either get to use a different diamond that you don’t like or the assistant’s going to get their tail up out of their chair and go to the supply room, get another bur and come back. Lots of delay.

So what are we, we’re fighting against every second of everyday. There’s delay and wasting time. So there’s a way, there’s a way to full proof you bur blocks. And so that way, the staff, they always know, “Okay, we’re missing a light blue diamond.” That’s a you know, we call it a sharp diamond in my practice, I just use common sense terms for everything. Okay so they know to get another sharp diamond if that one’s missing. Whatever color it is, it just clicks and there it is. You don’t have to think about it. Supply area, this is our central supply stocking area, okay? So every template has a color in the background. Composite resin is orange, every one of these supplies coordinates to a supply the row of orange bins in the supply area. So now, the staff not only knows when the thing is set up exactly right, they know when they’re setting it up if they come to the supply room and we have this little blue baskets they used to carry supplies from here to the room. They know if they take one supply out of each orange bin, then everything that needs to go into the room for a composite resin should be there. You don’t have to think about it, right? they just pull one supply in each bin.

And of course, every now and then you miss one; whatever. But the template tells you if you miss it. So there’s no way the doctor ever gets to the room without the thing being there and this really speeds it up for the staff. And we tested everything you could possibly test. We tested just having a lot of bins and the thing that hangs people up on this, they don’t like is I will have, like let’s say I use a lot of Septocaine. Everybody like to use septocaine pretty much? Right. So I will have a bin of septocaine in the orange row, a bin of septocaine in the yellow row, in the blue row. So I have multiple places that I have septocaine, right? My staff or in the beginning they would say this and the staff that I teach will always say, “Well that’s stupid, now when we’re stocking this room, we got to put 5 septocaine in 5 places instead of just one big bin. We could always get it out in 1 bin.” But it’s not just septocaine, it’s everything and that’s duplicated, right?

So it’s a heck of a lot easier when it’s a busy day, you know; Monday, Tuesday, Wednesday in my office and we’re cruising and trying to get to 12,000. It’s a heck of a lot easier for the staff just to put a bucket down and put one thing out of each bin in a color and go to the room then have to try to think, “Okay for this procedure, he needs septocaine, he needs brushes, he need binding agent, he needs this.” You know, if you just have…if it’s just in one place, then you have to remember every single time you need to get a supply. But if you have multiple places and they’re all color coded, you just go Boom boom boom boom boom! To the room off you go. This cuts down setup room times by minutes. I mean, 6-7 minutes probably per procedure. Okay, yes. Let’s answer questions. Yes, okay okay, yes. You know we tested a couple of ways, I actually tried doing like a you know, you see a butcher paper, we have it on a roll when you tear it off. That turned out to be really, hey hard to get somebody to print and be complicated.

It turned out to work better for us, we just printed the one poster for each procedure, and then we had it laminated really good with what they call a quarter inch, edge seal lamination. And so when you’re measuring your counter space, be sure that you leave off at least a quarter of an inch all the way around the edge because you need that quarter of an inch for the lamination to stick over the poster. So over time, as the lamination kind of frames, it never get to the poster word and de-laminate. It’s really strong, I mean it’s…after the fire, it’s one of the things I was able to dig out of the ashes and save. I actually dug them out, cleaned off the black soot and they’re still fine; I mean they’re that good. The lamination is that good on those things. So yes, that’s how you do that. This is usually like the concept that people like. Normally, so this is the one like people really come down to my office and see when they come to my office.

Here’s the route board, okay? So in Toyota, they have these Kanban signal boards. Okay? In Toyota, they always except there are big old fancy ones, right? But they, everybody in the factory knows how things are flowing down the line every second of every day, okay? And that’s, I mean this is just one of those concepts if the workers now how things are flowing, it keeps everybody on track and motivated. So I thought how can we put this in a dental office. And so, this is…I got this from my trip down to visit Monticciolo’s office as I was telling you about this morning. He had a little bitty tiny board and he didn’t really connect it to…he’s got his idea from just a surgery board at a hospital. He had a little bitty one, he didn’t even look at it, it was just for his team because he had a lot of ops; 17 ops crazy, something like that. And so they would write on their stuff that they were doing and I thought, “Man, that is a great concept. How could I take this concept and make it work for my office? Because in my office, I’m also always searching for ways that I as the doctor could make my life easier too.”

So this board solves a lot of problems, not only does it keep the entire staff with knowledge of what’s going on in the practice every second of everyday, but it also lets me, as the doctor, focus on what I’m doing chair side, get up, walk out of the room. As I’m walking out of the room and I’ll show you some pictures here in a minute. I have these, I have TV monitors all over the office that have an image of the board at all times on it. So I’m always within a couple of steps of seeing the board. That’s all I do all day long, this is my life. Drill, drill, drill, stand up, walk out in to the hall, look for number 1 priority, go to whatever room that tells me to, in this case, room 5. Do whatever the board tells me, check hygiene, do that, walk out of the room, look at the board, find the new priority 1, and that’s my life every day. Monday, Tuesday, Wednesday.

I never have to worry about the other 4 things that are going on in the office. I only focus on priority number 1, okay? But to get it to work right, you have to have a person in the office that’s good enough and responsible enough to be in charge of this thing. It’s usually the team leader, usually the clinical team leader because if you don’t have somebody in charge, you get screwed in a hurry. But let me tell you, when it’s clicking and this is one of the two things I’d say Dr. Ted has saved their practice. That’s how they can run 4 hygienists and he runs 4 or 5 ops. This is the only way that I’ve come up with that you can really efficiently do that.

Another Japanese concept, I don’t want to pronounce it, but it really means “Boots on the ground”. So in Japanese culture, even the highest top of the highest top at Toyota, the CEOs, they’re really in charge periodically and without, you know telling anybody, they will go down to the floor of the factories or the offices. And they’ll walk around and they’ll ask questions and they’ll you know, they just a little here and a little there. They’re really not trying to…they’re not like trying to solve the problem themselves. What they’re trying to do is just make sure that they’re just keeping their pulse on everything and make sure that the team knows at any time, “Hey the doctor might check on me.” You know. “The CEO might check on me.” You just don’t know. It just keeps everybody prepared and you know, if you try to be one of these…if you try to be a doctor, who’s you know, pretty much just works on patients and stays in their office. And doesn’t ever get involved in the day to day operations of the practice, it’s going to end poorly. There’s no way that that’s ever going to work out long term. You’ve got to keep your pulse on the practice a little bit.

Always look for these Nekkus. Nekku is a Japanese word for blockage. And so no matter how good you get, there’s always little things that can trip you up and block you along the way. Finding those and getting your team to be comfortable enough, we need to tell you what they might be. That’s the tricky part. If you solve that one, there’s always some little something you can improve that’s a little blockage in your office. Muda is the Japanese term for waste. The reason I put a stopwatch up there is because I think that time is by far the most wasted precious resource in history. I had doctors, a lot of doctors in the program will say to me, you know I’m just worrying so much I don’t ever feel like I can take a vacation. And a lot of times, after I interview him close enough, I figure out, they are taking a vacation. They’re taking a vacation, 15-30 minutes of the time sitting in their office twiddling their thumbs when they could be doing something to make sure their practice was running better so they didn’t have time to sit in their office, right? So they took their vacation every day.

I would rather work my tail off and take a 4 day weekend every week. Muri, this is the Japanese term for over burdening. You have to be careful because you know, you can get into low power trip like I probably did in the late 2000’s and when I thought I was smarter than everybody and we had this practice booming and you know, the February before the fire, you know my prices were low. We did right at 200,000 that month and I thought I was a genius but I have a tendency to ask too much of my staff at that time. And so you now, you got to be a team together and I was probably asking them to do too much at times. So you just have to always be conscious. I’m always usually at the side of the doctor, because I’ve seen so many teams that had this one person that’s so you know, mean and everybody kind of gets lazy because they hate that person and all these. But when you have a team like some of those people that are truly on the team. You know, they want to be for the practice and they’re truly, honestly on your side and they’re working for you. You know, be conscious and don’t overburden them.

You know, be like my buddy that had a staff that walked out on him 3 times. You know, those people felt overburdened. If you have a good team, don’t overburden them. This, I already talked about this, the concept in Japanese is Just In Time. Delivery, you know it’s something that Toyota does, if they need 400 tons of steel in a month, they don’t have 400 tons of steel delivered to the site once a month. They’ll have whatever it is, a couple of tons delivered a couple of times a day; which I thought was interesting. But they think it’s more productive and efficient to always be feeding things at the time you need it. And so the way this applies to dentistry, the way this applies to dentistry is…what do you guys think? If you were to say that we’re selling something at the dental office. What do you think that that would be? Most people, I’ll just tell you so we’re on 300 slides. You know, the easy answer, you knew I was fishing for something different so why nobody said it. But normally people would say, “Well we’re selling fillings, crowns, root canals, stuff like that.” Right?

But truthfully, it’s not what we’re selling. What we’re selling…because this is the commodity that’s really fixed and we cannot, once it’s gone we can’t get more of it. We’re selling an available dental chair of time, a block of time with a dental chair that’s perfectly set up for procedure. So the trick is, getting the patient into that block of time that’s what we’re actually selling. The patient is variable, it’s a variable change. And the procedure’s a variable change. But a perfectly setup room, an operatory with a dental chair waiting for that to happen, that’s what we’re selling every day. And so as the day goes by, if you have a chair that sits here without somebody in it, and without me working beside it for an hour, that’s an hour that you can’t get back. Okay? So the thing that we’re trying to deliver just in time in the same day dentistry concept blends in with it so well, is we like to have all these color coded stuff and everything is set up to deliver the operatory in perfect condition just at the time that the patients come in and you need to use it. Okay? If you can get it in your head that what you’re really, your objective each day is to make sure that if a patient needs dentistry, I have an operatory ready for that to receive that person when they would like to do it. That solves a lot of problems for you.

It really, really does solve a lot of problems, you know. It just really does. So hey, that was it guys. That is, that’s my wheel house, the Lean Management theory applied to dentistry. That is what I’ve made my mark I guess with, at my practice and also speaking around the country. That’s what everybody really wants to hear about I guess that I’ve applied well to a dental practice. So I’m excited to share that with you guys. Now next week we’re going to continue on a little bit and let’s maybe we’re kind of getting away from the Practice Achievement Formula but we’re also going to sort of finish up some lose ends. We’re going to get into scheduling and all that kind of cool stuff and Oh, you would want to listen to that one because scheduling can be one of the most complicated things in the practice. And if you don’t understand it as the doctor, how in the world are you ever help anyone correct the problem, right?

So tune in next week, we’re really excited about it. We’re so happy to have you as always. Thank you for your comments, reviews. If you want to drop us some comments about season 2 which we’re preparing right now, go to the website and in the comments section, drop us a line. We’d love to hear from you, we’d love to find out what you’d like to hear about next season because this season is rapidly coming to an end. I think we’re going to probably do 20 episodes this season. Then we’re going to take a short break and jump right in with season 2. Okay? Well thanks everybody for listening and we will see you next time.

We appreciate you joining us for this episode of the Dr. Chris Griffin Show. Be sure to visit drchrisgriffin.com for the latest resources and updates to keep you more productive every single day you’re at the practice. So when you’re not working, you can do the things that matter most in life. We look forward to having you join us in another episode of the Chris Griffin Show; where the doctor is always in.