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[QualitiAmo - Stefania]

Un dentista può diventare "lean"? Sembra proprio di sì...

Su Evolvment Excellence potete leggere un articolo dal titolo: "5 Questions - Meet Dr. Sami Bahri, the "Lean Dentist"".

Questa è la versione tradotta in italiano con il traduttore automatico di Google.

In this edition of 5 Questions we meet Dr. Sami Bahri, sometimes called "The Lean Dentist," and author of the recently-published Follow the Learner: The Role of a Leader in Creating a Lean Culture.

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1. Who are you, what organization are you with, and what are your current Lean-oriented activities?

I am a full time practicing dentist in Jacksonville Florida, since 1990, and co-founder of the Bahri Dental Group, where we practice Lean Dentistry, to the great benefit of our patients and our practice.

I was born in Lebanon where I received my dental degree from the Saint Joseph Jesuit University. I spent three years in Paris, France, specializing in dental prosthetics, and upon my return to Lebanon started teaching dentistry. Soon I became chairman of the Fixed Prosthodontics department, and in 1984 was appointed as the founding director of the dental school at the Lebanese University. In 1990 I moved to Jacksonville, Florida and started my dental practice and the search for the optimum management system.

Opening three consecutive dental offices, starting a dental Prosthodontics department, heading the founding team of a new dental school and experiencing dentistry in Lebanon, France, and the U.S. gave me the opportunity to learn, in diverse environments, how to implement new ideas through team efforts. But it also left me with many unanswered questions on management and leadership.

To find the answers, I have studied any information I could find through books, audio and video-tapes. I chose Lean Management because of its track record at Toyota. It appealed to my desire to apply to management the same scientific logic used in dental treatment. In March of 2007, we presented our work at the Shingo Prize Conference and were awarded the title of “World’s First Lean Dentist” by the Utah State University and by the people in charge of the Shingo Prize for Manufacturing Excellence.

My current Lean-oriented activities revolve around perfecting the concepts described in my new book, Follow the Learner: The Role of a Leader in Creating a Lean Culture. With the Lean Enterprises Institute’s help we tried to summarize the journey, the experience and the thought process that led to our implementation of Lean in dentistry. Originally, we had targeted the Lean practitioner who, like me, had learned Lean and tried to implement it, with or without success. After the first draft, we decided to keep the content, but simplify the text to make it accessible to the Lean beginner.

As for the size, we ended up with 88 pages although our goal was 60-70 pages. Why a small book? Two reasons. First, because most management books are bought but not read— possibly because of their size. We wanted every employee in every company to read the book in just a few hours and be able to implement some of its ideas immediately. Second, because we wanted to write a lean book on lean. Only what is necessary and sufficient. No words muda. No ideas muda.

Our final challenge was to make it clear that the book is not exclusively about dentistry, but about Lean in any industry. We hope to have achieved those goals, and that others would learn from our experience; and mainly, that they would help us to improve our approach.

Today, our activities cover four fronts, 1) Perfecting the dental management system. 2) Refining our message to our dental colleagues 3) Communicating with service industries to show that Lean applies to their businesses to the same degree as manufacturing and 4) Communicating with manufacturers to tell them:” If Lean applies to the dental office, don’t tell me that it doesn’t work in your manufacturing environment.”

2. How, when, and why did you get introduced to Lean and what fueled and fuels the passion?

In 1993 I read the book Kaizen, and got attracted the Lean philosophy. But the real eye-opener was Lean Thinking by Womack and Jones. Jim Womack tells the story of his daughters folding their mother’s newsletters. “…why don’t you finish one at a time?” He asked them. “Because it wouldn’t be efficient” they answered. In 1984, while in charge of the dental school, I had had the same idea, treating one patient at a time. But I dismissed it:” Dental schools have been around for a long time” I thought, “People must have tried it and failed.”

The dismissed idea was revived by Lean Thinking. I went to the bibliography in the book and studied Ohno, Shingo, and others. Then we learned the different Lean tools and applied them to dentistry. In 2005 we finally reached the long awaited performance breakthrough.

What has always fueled the passion? The desire to find the truth—true solutions to real problems. Isn’t that the premise of all scientific research? And when the present state of science fails to explain something, we turn to spirituality and faith to know the truth. I want to find the truth about leadership, management, and dental care. I know that the truth is relative, and multifaceted, but, imperfect as the concept is, only that pursuit will lead us to finding true solutions to our patients’ problems.

What do we get in return? A sustainable competitive advantage, very difficult to copy, especially by a competitor focused on the practice’s efficiency and productivity instead of the patient’s well being.

3. In your opinion what is the most powerful aspect of Lean?

Its inclusiveness—no person or idea is excluded, as long as they contribute to process improvement. Sometimes I find it difficult for a new management system to emerge separately. Lean would have no problem including it, and using it for process improvement. It is impossible to predict the future, you might say, and I have to agree, but that’s how far I can think today.

One aspect of this inclusiveness is Respect for people; an insider, an outsider, a CEO or an assistant or a supplier, everyone is welcome to improve and help solve problems.

Another aspect is Respect for ideas, wherever they come from. You can borrow from Six Sigma, TQM, the theory of constraints, as long as you improve the process. You want to use a control chart? Reengineer a whole value stream? Just prove that it works and you can integrate it. Including ideas from other disciplines will only strengthen a business’s adherence to Lean principles. An idea is evaluated only by what it brings to the system.

4. In your opinion what is the most misunderstood or unrecognized aspect of Lean?

One aspect cost me many years to understand -- the waste elimination trap and how flow can save us from it.

We learned that waste needed to be eliminated; we looked around us for any of Ohno’s seven wastes and removed it—for 13 long years. What did we get? Only marginal improvements! The problems did not change. We were still running hours behind schedule every day, and resources were drained uncontrollably.

Today, when I visit companies trying to implement Lean production, I find them falling in the same trap: worshiping removal of the seven (or eight, or nine) wastes, and their elimination from their existing “batch and queue” systems. They can spend their entire professional life doing it, but they won’t see tangible results unless they switch to flow production.

Removing waste is very important, but the time you spend analyzing it does not add any value to the product. Can we minimize the analysis time? Yes, by implementing flow. Isn’t that what Taiichi Ohno did when he started experimenting with TPS some sixty years ago?

When you watch a product, or patient treatment, going through its value stream, it is either flowing or not. Two possibilities are easier to control than seven. To take advantage of that simplicity, we have created the position of a Patient Care Flow Manager; she watches all patients in the chairs, for flow or no flow. If she sees obstacles to the flow of treatment, she removes them. That would need analysis too. That analysis is a necessary waste that we accept it as long as it eliminates the root cause of the problem.

Analyzing waste and eliminating it in a “Batch and queue” system comes from the “time and motion study” era. Where is it weak? We could be analyzing and improving unneeded operations. Starting from flow eliminates most of those operations, and the time we would have spent analyzing them. So we need to flow the patient through the system first, then we can analyze and remove the forms of waste that stand in the way of a better patient flow.

Let me take this opportunity to discuss the crucial distinction that we make between flow and one-piece flow. Although they are often used interchangeably, my experience tells me that, from a practical standpoint, understanding that difference is essential to the long term success of a lean transformation. When we say one piece, we are quantifying our goal. Limiting the number to one, adds the much needed rigor to the concept of flow. Just talking about flow seems too lax. It could be a two-piece flow or a fifty or a thousand-piece flow. But, aren’t those batches? Whatever the size of the batch, we might be tempted to be complacent and think that our processes are flowing. A one-piece flow ideal makes it simple, as long as you are flowing more than one piece at a time, you need to make more efforts to reduce the number of those pieces.

As far as I know, One-piece flow has never been totally reached anywhere, which makes it like perfection—unreachable, but good at guiding our improvement efforts—a true north. We try to reach one-piece flow, but we end up flowing more than one piece at a time, and that’s what we call Flow.

5. In your opinion what is the biggest opportunity for Lean in today's world? How can that be accomplished?

There is an immediate opportunity, and long term one.

The immediate opportunity is Healthcare, because it is expensive, and because it is getting a lot of attention lately. We need a campaign similar to the Training Within Industry (TWI) program in WWII. Healthcare institutions and providers need to learn Lean, through TWI methods probably, and use it to improve healthcare delivery. Delivery should be the focus for cost cutting and for quality improvement. I can imagine two stages. First we need to learn how to flow patients through our systems. Their stay in the system should be equal to the treatment time, no more (for cost control), no less (for quality control). The treatment time is subject to many variables, but we can ignore them as long as providers spend with patients just the length of time they need for good quality. The second step would be to continuously improve and shorten the treatment time itself, through waste elimination.

The long term opportunity is to teach Lean to the entire society. I would start teaching it at schools, as early as possible. As lean practitioners, we know it works in every aspect of life, so why not teach it in every aspect of life. Professionals graduate with very little management knowledge; doesn’t that need to change?

The global market is seeing many emerging nations rely on Lean production. To stay competitive our children need to learn management, efficient production, and leadership skills. The earlier we start teaching Lean, the faster we could unlearn batch thinking.
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Stefania - Staff di QualitiAmo

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[dario]

che ora, ispirati dalla qualità, i dentisti magari ci propinino anche fatturazioni lean?
sarebbe mica male...

[dbosnjak]

Questo ed altri argomenti simili sono solo a dimostrare che il lean non è applicabile solo a una azienda manifatturiera, ma ad una azienda qualsiasi, sia di prodotti che di servizi.
Ed è applicabile in casa, in gita, al lavoro e in qualsiasi attività che si può rappresentare attraverso un processo ed un flusso dei materiali/informazioni attraverso di esso...
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Uno standard che non è cambiato nell’ultimo mese è uno standard vecchio.
Taiichi Ohno
D. Bosnjak

[Stregatto]

Proprio così!! I principi della produzione snella sono universali e applicabili da chiunque abbia la buona volonta di provarci. Ciao e bentornato sul forum!

[dbosnjak]

Bentornato dopo un pò di vacanze passate in coda... (mi sembra una cosa poco lean ma la dovevo sopportare...)
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Uno standard che non è cambiato nell’ultimo mese è uno standard vecchio.
Taiichi Ohno
D. Bosnjak