When you have a demand for services, you will need supplies. In Principle #3 from the book, The Toyota Way, https://thetoyotaway.org/ 14 Management Principles by Jeffrey Liker, we are looking at the use of the inventory and service “push and pull systems” to avoid overproduction and waste. Overproduction is the lack of proper utilization of motions and movements in the workspace that adds no value to the patient experience. Examples would be the number of set-ups and treatment room changes to process a patient that could happen in one room with fewer instruments and fewer steps by the providers. Waste is defined as any use of time, money or other resources that do not add value or contribute to the best delivery of healthcare to the patient and costs the practice more money. Pull production is when patients are treated when they have requested service or are ready to receive treatment eliminating unnecessary waiting time. The downline customer in the dental office are patients who have successfully received their services. The manner in which the services are performed also can be defined as a “push” or “pull”. In the “production” process of delivering dental care you want to give the patient/customer the following:
1. What they want and need.
2. The number of services that they want in one appointment versus several
3. When they want it without wait time spent in the reception room or treatment rooms.
Making sure to have the materials/equipment in stock to complete the services without waste or “dead money” can be challenging. The dentist is in the business of “selling” dental services and products that will “use up” the inventory.
A “push system” example is when dental supply representatives encourage dentists to purchase new products or volumes in supplies to get a cost break whether or not there is an immediate need for the supplies or not. The money spent is now inventory or "dead money" because it can't be allocated for any other expenses that are more critical to operations.
“Dead money” is oversupplying to the point that money is spent to stock and manage supplies and materials that will not be used for months or years or perhaps never. The basic idea is to replenish what has been taken away. For instance, let's take Dr. Bain (not real name) who purchased blue light oral cancer screening technology at a promotional price of $1500.00, and has never used it. Scientific evidence of detecting pre-cancerous oral lesions is essential to the well-being of all patients. The plan was to sell the patient on the value and have them pay a small fee in return. Dr. Bain received resistance from his hygienist about charging for the screening exam; thus, to avoid conflict, he “shelved” the product.
There are many products and services that dentists purchase and intend to sell to patients such as new whitening procedures, Invisalign, implants, veneers, laser services, endoscopy, antimicrobials and oral health care products. The dentist and the team do not envision how to incorporate new products or services into their daily routine. There is a lot of wasted time and motion at the front desk that causes bottlenecks and wait times for patients and patients are dismissed without discussion of treatment and products. When the patient does come in for an appointment, there isn’t enough preparation and planning and often the patient has to come back more than once for the same problem.
Getting the supplies that you want when you need them is a key to continuous flow. Many practices run low on commonly used supplies only to have things "back ordered." Moreover, on top of that, the supplier charges “rush” fees to deliver goods the customer needs or sets them up on an auto-delivery system that can result in over purchasing. Working with the supplier to give you a good cost when you need to replenish what you have used up eliminates an elaborate inventory system and waste of time and resources.
Having just enough for the anticipated needs of the patients is better than an overstocked practice that now wastes valuable space and resources to manage inventory.
In today’s world of immediate delivery, some sources can accommodate dental practices with a promise of faster delivery at low prices.
The Toyota Way is not about managing inventory it is about eliminating it. The “pull” system is having enough of the right supplies “just in time” to finish the work. Being able to give patients the services and the products when they want them contributes to the continuous flow so desired in smooth running practices. Goods should be there when we need them so that there is little inventory and no waste. Products and services that you have purchased should have a planned usage based on patients wants and needs. Patients look to the dentist to educate them on services that will improve their health and well-being. Products sitting on the shelf don’t sell themselves and services that you can provide don’t get purchased unless you promote to your patients/customers.
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