Lean Concepts for the Dental Office Erin NorrisMuller

Lean Concepts for the Dental Office Erin Norris-Muller Danaher Corporation

a leading industrial company, designs, manufactures, and markets innovative products, services and technologies with strong brand names and significant market positions. Dental Approximately 80% of Revenues from 6 Strategic Platforms August 11, 2005 Company Confidential Page 2

Danaher Brands

DANAHER BUSINESS SYSTEM INNOVATION DEFINES OUR FUTURE THE BEST TEAM WINS DANAHER KAIZEN IS OUR WAY OF LIFE QUALITY DELIVERY COST INNOVATION CUSTOMERS TALK, WE LISTEN WE COMPETE FOR SHAREHOLDERS

Danaher Core Values Continuous Improvement (Kaizen) is our way of life • The Danaher Business System IS our culture. • We aggressively and continuously eliminate waste in every facet of our business processes.

What are the Eight Wastes? zzz zz Wrong info Info missing Keypunch error Quality Defects Motion Sign-offs Inventory 12 1 9 6 4 10 8 Waiting No way! 13 2 Over. Processing 3 Over. Transportation Production 11 5 7 Unused Creativity

Causes of Waste • • Functional organization IS technology gaps Excessive controls Outdated process design No back-up/cross training Unbalanced workload System batching Outdated policies • Changing priorities • Responsibilities not defined • Poor visual control • Disorganized workplace • Lack of training • Obsolete forms • No SOP’s • Authorization levels

DBS tools • • • Strategic Planning Policy Deployment Value Stream Mapping 5 S/Visual Management Standard Work Cooperative Business Planning • Value Selling • Voice of the Customer • Danaher Development System • Strategic Supplier Integration • Production Preparation Process • Transactional Process Improvement • Problem Solving • Variation Reduction Kaizen • Six Sigma • Design for Six Sigma

DBS tools • • • Strategic Planning Policy Deployment Value Stream Mapping 5 S/Visual Management Standard Work Cooperative Business Planning • Value Selling • Voice of the Customer • Danaher Development System • Strategic Supplier Integration • Production Preparation Process • Transactional Process Improvement • Problem Solving • Variation Reduction Kaizen • Six Sigma • Design for Six Sigma

Benefits of DBS • • Reduce redundancy in work Reduce errors in quality of information Improve efficiency Reduce time spent waiting for others Reduce time/distance spent walking Create standard work for all to follow Reduce amount of communications needed while improving quality of the communication itself • Consolidate amount of places for storing information

Distance Exercise Daily Requirement: 40 Orders Enter Order And Print Hard Copy File Hard Copy 30’ Feet per (8 hour) day ______ Feet per (5 day) week ______ Feet per (240 days) year ______ Miles (5280 ft. ) per year ______ Hours (Miles/2) Pickup Next Order @ Fax ______ 20’ Associate performs 3 tasks to complete 1 order

Distance Exercise Daily Requirement: 40 Orders Enter Order And Print Hard Copy File Hard Copy 30’ Feet per (8 hour) day 4, 000 ______ Feet per (5 day) week ______ 20, 000 960, 000 Feet per (240 days) year ______ Miles (5280 ft. ) per year ______ 181 Hours (Miles/2) Pickup Next Order @ Fax ______ 90. 5 20’ Associate performs 3 tasks to complete 1 order

What are the Eight Wastes? zzz zz Wrong info Info missing Keypunch error Quality Defects Motion Sign-offs Inventory 12 1 9 6 4 10 8 Waiting No way! 13 2 Over. Processing 3 Over. Transportation Production 11 5 7 Unused Creativity

Reducing waste • 5 S/Visual Management and Standard Work DBS tools • Advances in caries detection and digital xray technology

What is Standard Work? Its not about working harder Its about working smarter What’s working smarter? • Being able to accomplish the same amount of work in less time. • Giving the customer what they need.

Continuous Improvement = Change Everything we do is part of a process… …all processes can be improved process output inputs

Determining What is a Noise and What is a Constant NOISE CONSTANT Something that we do not control today or may vary Something that we control today or does not vary BRAINSTORM WAYS TO CONVERT NOISES TO CONSTANTS – CREATE SOP’s

Levels of SOPs NOISE: Some orders are received with incomplete information Level 1 OK Something on Document current process Paper Level 2 Better Level 3 Best Change to the process Identify and attack waste Irreversible change to the process / Poka-Yoke Error-proof the process We want to strive to achieve SOPs that are Level 3

Standard Work Guidelines Standard work should be: • A precise description of each work activity. • Created and documented by stakeholders • Always followed by everyone performing the work • Revisited and refreshed every 90 days • Owned by someone

Exercise 1 5 11 8 10 6 4 3 7 9 2

DBS Tools – Visual Management 4000 3000 5000 2000 6000 1000 Tachometer 7000 0 8000 60 50 70 40 80 30 90 20 100 MPH 10 Odometer 110 0 120 E F Gasoline Oil Brights Battery Trip-O-Meter 00236 Lights TAPE Air Conditioning Heat Defroster CD 90. 55 FM

DBS Tools – Visual Management Would you stay for the end of this game? INNING VISITOR HOME 1 2 3 4 5 6 7 8 0 0 1 0 2 0 1 0 0 3 0 0 BALL: 3 STRIKE: 2 9 R H E 4 7 0 4 6 1 OUT: 2 ON BASE AT BAT: POSITION: AVG: HR: RBI: #37 RF. 279 12 43 PITCHER: ERA: W-L: K’s: BB’s: #42 3. 59 11 -7 5 1

DBS Tools – Visual Management The team you were cheering for scored home runs! Did you stay to see it? Visual Management allows us to know what is happening when walking into a situation.

Principles of visual management • • Three second rule A picture is worth 1000 words Color coding One page

Is this Good Visual Management? You approach a crosswalk at a stoplight and see these signs:

Contents of Instructor Kit

Visual Management Next step operatory Owned by Lead Assistant & Office Manager

X-ray set up Paper towel Sensor sleeve Finger cot Bitewing tab Snap-a-ray Mask Edge-Ease IOC Camera sheath Blood pressure cuff

Visual of “Proper Workstation Setup posted in each x-ray room

What is 5 S? • 5 S Is: – A process to ensure a clean, orderly, safe and productive workplace.

What are the 5 S’s? ¶Simplify Clearly distinguishing between what is necessary and what is unnecessary and disposing of the unnecessary. ·Straighten Organizing the necessary items so that they can be used and returned easily. ¸Scrub Cleaning floors, equipment, and furniture in all areas of the workplace. ¹Stabilize Maintaining and improving the standards of the first three S’s. ºSustain Achieving the discipline or habit of properly maintaining the correct 5 S procedures. (Seiri) (Seiton) (Seiso) (Seiketsu) (Shitsuke)

SIMPLIFY Clearly Distinguishing Between What is Necessary and What is Unnecessary and Disposing of the Unnecessary Identify Truly Needed Items – What is it for? – Why do I have it? – How often do I use it? – Does someone else have the same thing?

STRAIGHTEN • Proper Locations • Storage Methods • Location Marking • Shadow Boards • Sign Boards

STRAIGHTEN

SCRUB • Cleaning Floors, Equipment, and Furniture in all Areas of the Workplace • Establish a Clean Workplace. – Clean up the Area. ÜSweep & Wash Floors ÜClean in, under, and around Equipment and Furniture ÜEliminate all Trash from Workplace – Keep in mind: How do things get dirty? - Fix the root cause of the dirt.

STABILIZE Maintaining and Improving the Standards of the First Three S’s • Maintain and Improve the Clean, Organized Workplace – Eliminate excess storage areas and flat surfaces – Make changes to equipment that make it easy and quick to clean and eliminate dirt and leaks at their source – Use check list to establish daily cleaning and organization activities – Institute 5 S Patrols to monitor 5 S progress

SUSTAIN DANAHER BUSINESS SYSTEM Achieving the Discipline or Habit of Properly Maintaining the Correct 5 S Procedures • Develop a Habit of Simplifying, Straightening, Scrubbing and Stabilizing Your Workplace • Everyone Has to Accept 5 S as a Personal Goal • People Follow Examples (Good and Bad); Set a Good Example

Conventional Detection Method • If surface caries, the explorer sticks • If no stick, assumption is no carious lesion • But see what the Dr or Hygienist Doesn’t?

Versus Other Methods? Source: Lussi et al. , Quintessenz 54, 10 (2003)

Diagnodent Changes the Way We Detect Caries • Scans below the surface • Basically it is a “Three Dimensional Explorer”

The principle of fluorescent iridescence • A tooth surface fluoresces when irradiated by a light of a given wavelength • This fluorescence changes according to the optical characteristics of tooth tissue, associated with bacteria. The value of this change may therefore give an indication of the extent of the disease process

DIAGNOdent LASER specification Type Solid State (Diode) Light Output < 1 m. W Wavelength 655 nm (latterly 652 nm) Voltage 7. 5 V (5 x 1. 5 V type AA) Classification Class 2

The principle of DIAGNOdent • Light is emitted from the solid-state LASER, at a fixed wavelength • The probe tip incorporates two-way fibre optic bundles • The incident LASER beam is carried by the central fibre optic bundle and the reflected LASER beam is carried by the peripheral bundles

DIAGNOdent mode of operation LASER Emission Transmitter & Receiver Fluorescence Electronics Digital reading 05 12 Moment / Peak Loudspeaker

DIAGNOdent digital display • “MOMENT” display gives the current realtime value being measured as it continuously changes from second to second • “PEAK” display gives the maximum value recorded during any single tooth measurement • DIAGNOdent will switch off automatically if not used for more than approximately two minutes

What do the values mean? • Research has shown that it is possible to correlate values with disease progression (Lussi et al, 1998; Longbottom et al, 1998; Reich et al, 1998). • From this work it would appear that: • values between 0 and 10 correlate with sound enamel • values between 10 and 20 correlate with outer enamel caries • values between 20 and 30 correlate with lower enamel caries • values over 30 correlate with dentinal caries

Dental x-ray technology

Dental x-ray technology

Dental x-ray technology 66% reduction in steps 80% reduction in time