This article represents the 4th post about integrating the 14 management principles of The Toyota Way into the daily processes of dental practice.
Principle #4 from the book, The Toyota Way, 14 Management Principles by Jeffrey Liker, discusses the elimination of the unevenness of the workload on the team members and the idea of “working like the tortoise instead of the hare." Working consistently and engagingly or slower like the tortoise causes less waste of time than hurrying through and making mistakes or needing a break to recover like the hare.
The average day in a dental office finds the employees engaged in work that is either indirectly or directly involved with patient care. Some days are chaotic and “overbooked” and other days find the professional staff sitting around waiting for patients or spending more time on the patients in the chair without necessarily adding anything of value to the visit.
The Toyota Way Principle #4 addresses this unbalance in the production level by focusing on "leveling out" each day to standardize the production by applying "pull systems" when necessary. Pull systems as discussed in the previous article about Principle #3.
The pull system is to eliminate the 3 Ms, Muda, Muri and Mura as defined by the following:
#1 Muda is determined by the 7 (or 8) toxic wastes.
The non-value-added wasteful activities such as too long appointment times caused by extra movements to get supplies, handpieces, equipment, and available staff or anything that causes the patient to have to wait for products or services.
Sometimes an 8th waste is brought into the mix, and this is the "waste of human creativity." When someone's ideas for improvement aren't explored, brought to light, tried out, etc, then this is a waste.
#2 Muri-the overburdening of personnel or equipment. Undue stress of an overbooked schedule can push people and resources beyond their natural limits.
When irrationality focuses on questions like which patient/tray is next, are these correct, two different standards which one is correct? This is often “strain” that is happening inside someone’s head that can cause someone to not focus on keeping safe, doing the job as it was designed, not following the standard practice, etc
#3 Mura-is the unevenness that ensues by the fallout of M#1 and M#2. "Normal" or "productive" days in the practice are more than the team and equipment can handle and other times there isn't enough work to utilize staff and materials. This unevenness on the overburdened days harms the perceptions of patients who can see, feel and hear the stress.
How do you develop people in an environment that is unstable? You want an assistant to take radiographs, but one day there is a line waiting for the machine, the next day nobody is waiting, and you have all the time in the world to do the job.
Quality team performance is difficult to maintain under this uneven production scheduling unless the practice is equipped every day to handle the highest level of production demands with equipment, materials, and people. The solutions to level out the work schedule are similar to that of manufacturing. Doctors and Dentists have plans with allotted time for procedures already mapped out so that they can level their work ensuring a reliable flow of income. Time is money in service operations. So, eliminating wasted time is crucial for dental practice success.
Think of the time and motion necessary in the simplest of visits such as a limited focus evaluation. The scenario plays like the following: patient calls in and schedules an appointment today. He arrives and spends 10 minutes filling out the new patient form and 5 minutes discussing his insurance plan. His information is quickly entered into the computer system taking about 5 minutes. The front desk now has to access his benefits online through a portal or by a telephone call. The dental assistant is alerted to seat the patient. He/she escorts the patient to the treatment room.
The patient is seated, bibbed, and the tray of sterile instruments is opened and placed on the tray table. The dentist enters the room, washes hands, puts on gloves and introduces himself/herself and quickly examines the patient and then orders radiographs of the area in question. He/she then leaves the treatment room going back to the previous patient, washes hands and puts on new gloves. The dental assistant takes the radiographs to evaluate the tooth. After the radiographs are taken, the dentist walks back into the room, washes hands and puts on gloves, and diagnoses the problem — root canal, build-up and crown necessary on tooth #3.
The dental assistant enters the procedures in the computer so that the front office can create a treatment plan. It is then printed by the front desk and walked back into the treatment room where the treatment costs with a breakdown including estimated insurance payment are explained and written consent is acquired.
Now think of the things that can and do go wrong that can occur within this scenario. If we work to eliminate those “hiccups” we will improve our efficiency and service to our patients. It is time to level out the workload and eliminate the 3 Ms of Muda, Muri, and Mura.
If you would like additional help, email Dr. Anderson at firstname.lastname@example.org