“Oh for Pete’s sake. Oh for Pete’s sake, he’s fleeing the interview! He’s fleeing the interview!”
-Marge Gunderson, Fargo (1996)
Joel Cairo: “You always have a very smooth explanation ready.”
Sam Spade: “What do you want me to do, learn to stutter?”
-The Maltese Falcon (1941)
Just another reminder, in January’s blog, waste was defined as, “anything beyond the absolute minimum amount of materials, manpower, or machinery needed to add value to a product or service”. (Flinchbaugh & Carlino, 2006) As I mentioned in that blog, there are seven main sources of waste in the dental practice:
• Overproduction
• Waiting
• Unnecessary Transport
• Over-processing
• Excess Inventory
• Unnecessary Motion
• Defects
In March’s blog, we discussed Overproduction and its possible application and impact on the dental practice
This month, we’ll talk about Waiting.
How often have we felt like fleeing the “interview” when made to wait? Or received unsatisfactory explanations for the cause of the wait?
Waiting not only affects patients, but the flow of the practice, as well. Waiting may be caused by a number on things, including:
• Poor scheduling
• Emergencies interrupting the schedule
• Late patients
• Inventory issues
- Out or misplaced
• Not keeping the schedule ‘sacred’
• Short-staff
• Etc.
In Lean parlance, Waiting may be defined as: Any downtime products or people spend waiting for material, information, or people. (Flinchbaugh & Carlino, 2006)
First, let’s discuss “Value Added”. For an activity to be value added, it must meet three criteria:
1. The customer must value it and be willing to pay for it.
2. It must fit the form, fit, or function of the product or service.
3. It must be done right the first time. (Flinchbaugh & Carlino, 2006)
So, what has “waiting” to do with these three criteria?
Remember, your customers are your patients, and the internal customers of your staff. Do your customers value their time? Do they hate to wait? Does the assistant setting up trays dislike waiting for the assistant responsible for cleaning and sterilizing instruments to provide them when needed?
Does your product or service provide that a patient in pain won’t have to wait days for an appointment? Does it provide that a patient doesn’t want to wait in the “waiting room”? The chair?
How about doing it right the first time? When a patient calls the first time with emergency pain, do you think it makes a difference to them if you can see them today, or next Monday? How about an new patient that has to cool their heels in the waiting room for 30 minutes in the waiting room before being seated, then another 15-20 minutes in the chair (and let’s face it, those chairs are not often real comfortable)?
When you decide that something in your practice is “Value Added”, it becomes part of what defines your practice and is untouchable. You must be committed to making it part of “who” & “what” your practice is.
Remember, waiting is waste. You’ve heard uncountable times that time is money, and the reason you’ve heard it so often is that it’s TRUE!
So, how do you reduce or eliminate waste? In the Toyota Way Fieldbook (Liker & Meier, 2006), Taiici Ohno of Toyota was quoted”
"All we are doing is looking at the time line from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that time line by removing the non-value-added wastes."
Let’s put that into dental practice parlance:
-All we are doing is looking at the timeline from the moment the customer requests an appointment to the point when we collect. And we are reducing that time line by removing the non-value-added wastes.-
That’s easy, right? Wrong! The entire staff must be committed to value-added service and its implementation. You must be willing to put your production, time on hand, unnecessary movements & actions under the microscope and take it apart to find out where the wasted time and action are that are causing waiting. And, as I mentioned before, this goes for:
• Patient scheduling
• Office flow
• Back-office flow
• Operatory production time
• Billing & collections
How do you make it happen? Make a goal:
• “We will add one patient to the schedule per day without working extra hours.”
• “We will keep production where it is and never close later than 5:00.”
• “We will never make a patient wait longer than 10 minutes in the ‘reception’ room.”
• Etc.
Then, as a team, tear it apart, find the waste, find the opportunities, look in the corners of your schedule and office flow, be committed to making the change.
In summary, if you are satisfied with your production and the product you as a team, or an individual, is offering, no worries. But, if you want to improve, and do it constantly and consistently, it will take work and dedication. It doesn’t have to be a drudge or daunting, even. Start small. Make the small changes. Get the habit started. Over time, you’ll find that you are making progress as quickly as you want and are committed to.
Next month: Unnecessary Transport. (I can hardly wait!)
Works Cited
Flinchbaugh, J., & Carlino, A. (2006). The Hitchhiker's Guide to Lean. Dearborn: Society of Manufacturing Engineers.
Liker, J. K., & Meier, D. (2006). The Toyota Way Fieldbook (A Practicle Guide for Implementing Toyota's 4Ps). New York: McGraw-Hill.