Lean Business is a corporate management philosophy aimed at maximizing efficiency and reducing waste, based primarily on the iteration of best practices and “learn & discovery”, making continuous improvements to products based on feedback from customers.
The Lean philosophy originated in Japan after the Second World War in the automotive industry, particularly with engineer Taiichi Ohno of the Toyota Motor Corporation. Ohno created an innovative method of industrial production, which proved so successful that it led to the definition of a new production model. This made it possible to respond to the need for flexibility, required by the post-war situation, while maintaining a high level of business productivity, and contributed to a considerable acceleration in the reconstruction of the country, leading to many achievements in the manufacturing sector.
The term ‘Lean Business’ was coined in the United States in the 1980s, thanks to various scholars who studied Ohno’s 2Toyota Production System and realized its clear superiority over the Fordism model of mass production, which had been applied until then, contributing to the spread of the Lean model worldwide.
The underlying principle of this philosophy is to increase the capacity to produce value and, at the same time, reduce anything that represents an unjustified waste of resources and time.
This may sound like common sense, but studies to apply the theory in practice to manufacturing operations are a valuable source of inspiration, not only for large companies in the secondary sector.
The principles of Lean Business have been successfully applied to the private and public health sectors and can bring about major improvements in smaller businesses such as dental practices.
How Lean Business models work
At the heart of Lean is a process that starts with careful observation, both in terms of analysis and data collection and through what is known in Japanese as a ‘Gemba walk’, i.e. visits to physical locations (‘Gemba’) of companies where the daily work takes place.
The process also includes interviews with the key players in the business, i.e. the staff, but also with customers, intending to detect possible problems, inconveniences, and inefficiencies.
Following the survey, it is necessary to organize the collected data into flow charts that describe what has been mapped in the simplest and most logical way.
In the case of dental practices, the focus will be on the patient journey, from the first moment the patient contacts the practice to make an appointment to the resolution of his/her problem.
Considering LeanBusiness models as mere cost-cutting and profit-optimizing strategies is a rough interpretation of the potential of these processes, which risks losing sight of one of the main focuses of this philosophy, namely people.
People are indeed crucial players in this scheme: listening to and discussing with staff is the only way to ascertain the real inefficiencies and, consequently, to implement the necessary solutions.
Moreover, in the medical-dental field, the ultimate goal is to make the business more and more capable of responding to patients’ needs, with the flexibility and in the time frame best suited to them, to reduce stress levels and improve the overall customer experience.
Following the survey and after having outlined the data and identified the intervention flows, it is necessary to act in order to reduce the problems and inefficiencies detected, putting in place new ways of working, which will then be constantly subjected to periodic implementation checks, following the cycle known as PDCA: “plan – do – check – act”.
Let’s see how this can be concretely applied in a dental practice.
Practical tips for applying Lean Business to dental practices
Let’s start by looking at some typical problems that can be encountered in the management process of a dental practice, that may lead to a deviation from the core principles of Lean Business:
- Problems related to overproduction, e.g. of unnecessary services, or activities performed too early or too late or lasting too long, causing a build-up of inefficiencies that have an impact on other patients and staff activities in cascade;
- Unnecessary movement of patients, staff, equipment, or consumables.
- Mistakes in inventory management.
- Unjustified waiting.
- Extra work, such as dividing work that could be done in one slightly longer session into two or more appointments.
- Repetition of work (caused by errors in supplies, or other inaccuracies).
The next step is to set up a plan of action to solve the problems encountered.
First of all, it is important to bear in mind that it is not useful to act on the final signs of inefficiency (e.g. to act on the specific operator who created a problem in the management flow): the principles of Lean Business teach us that the problem is always to be found in the system.
If the primary objective to be achieved is to resolve patient problems as smoothly and rapidly as possible, the ideal to strive for is the “one-piece flow”, i.e. a “single” workflow, not spread out over time, but as compact as possible. Specifically, it is more efficient to apply three dental crowns to the same patient on the same day than to apply one crown to three different patients, only to have them return twice each.
It is also better to have an optimal distribution of the workload between operators and spaces so that no one is left not busy for too long or is too overloaded to do the assigned tasks within the set time.
For the same reason, activities and their execution times must be designed to be perfectly synchronized with each other. Responsibilities, as far as possible, should be shared among staff, who should provide the necessary degree of flexibility.
A high level of automation (via apps for managing appointments or electronic tools for receiving payments) is also indispensable for reducing unnecessary work time and meeting workload schedules.
Therefore, the fundamental role played in the Lean process by the equipment and furnishings of a dental practice is clear: starting from the versatility of use of the stand-alone chairs, to the ease of maintenance and cleaning of the seamless upholstery made of leatherette with antifungal and antimicrobial properties and designed to be moved hands-free, and concluding by emphasizing the benefits for all those involved, operators and patients, in terms of comfort but also productivity deriving from equipment designed according to ergonomic principles.
When the balance is drawn, deciding to re-engineer the workflow of your practice according to the Lean Business philosophy is a process that can bring many improvements, but it must be approached with proper planning, observing how all activities are working, and targeting one area at a time to achieve ongoing improvements.
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