Lean methodology is associated with the rise of Toyota and the emergence of Japanese manufacturing, as well as the methodology’s subsequent adaptation in many different industries in the United States and around the world.

But one area where most people likely do not associate Lean is at the dentist’s office.

Maybe they should. In a recent article, Dental Economics editor Chris Salierno argues that it is time for dentists to learn how to incorporate Lean strategies, tools and tactics in their practices.

Salierno finds inspiration in the Toyota Production System (TPS) that provides the foundations for Lean, including Just-In-Time production. He wrote that TPS helped create the post-World War II Japanese economic powerhouse by increasing efficiency and cutting waste.

“Lessons from the TPS are not just for large manufacturers,” Salierno wrote. “Small businesses—and even dental practices—can adopt the Toyota philosophy and adapt it for their own purposes.”

How Lean Can Make Dentists Better

Salierno focuses on the application of Lean to office efficiency. He includes a number of Lean tools that will work well in a dentist’s office.

Kaizen: This term refers to the concept of bringing a team of employees together to focus only on one challenge, finding the root causes for the issue and then developing solutions.

PDCA: This refers to Plan, Do, Check, Act. It’s a fast, systematic way to address problems, implement a solution, verify whether it’s working or not, and make the necessary adjustments to improve outcomes. It works well for your New Year’s resolutions, too.

Just-In-Time: The fundamental idea behind Just-in-Time production is to reduce the amount of inventory by better calculating what will be needed to produce goods based on consumer demand. Salierno suggests it can help dentists set a monthly materials budget that keeps costs consistent and around 5% to 7% of overhead.

He also suggests that dentists familiarize themselves with Gemba, which involves managers (in this case, the dentist) learning about processes in their office by spending time with workers to find out what it is they do each day.

The World’s First Lean Dentist

Salierno is not alone among dentists in advocating the use of Lean. In the 1990s, Jacksonville, Fla., dentist Sami Bahri emerged as a practitioner of Lean in his office, earning him the title of “World’s First Lean Dentist.” He’s appeared as a keynote speaker at the Shingo Prize Conference, the annual event that honors business improvement and achievement. More recently, Bahri released a second edition of his book, “The Lean Dentist: Establishing One-Piece Flow in a Patient Environment.”

“Before I learned about Lean, I studied every management system available, trying to find out why despite applying sound dental systems we still had unresolved problems,” Bahri said in an interview. “In our hands, only Lean made a big difference at all levels, i.e., profitability, quality, patient experience, stress level, etc.”

He adopted Lean’s one-piece flow into one-patient flow. He said that in the context of dentistry, “One-patient flow means that once you started working on a patient, you should not stop, or have any delays in treatment between different providers, until their mouth is totally healthy and ready to enter the hygiene recall cycle.”

Applying Lean to Patient Management

Another dentist, Roger Levin, focuses on using Lean to address processes that involve how dentists manage their patients. By applying Lean strategies to common problems in dentists’  offices involving production and profitability, Levin suggests dentists can achieve the following milestones.

  • Keep 98% of all active patients scheduled at all times
  • Reactivate 35% of all inactive patients from the last three years
  • Decrease the number of no-shows and cancellations to just 1% of all scheduled appointments

Also writing in Dental Economics, Dennis McCafferty, a Lean Six Sigma Black Belt, said that Lean tools and techniques support better processes in dental offices. He pointed out two key metrics involving efficiency that dentists can apply: the amount of time patients spend receiving direct care vs. sitting in the waiting room (this should 50% to 70% direct care) and the amount of time staff spends on direct care vs. other activities (this should be 60% to 80% direct care).

In his article for Dental Economics, Salierno said applying Lean can lead to cultural changes in a dentist’s office.

“It’s time for dentistry, both small private practices and large DSOs, to learn how to be Lean,” he wrote. “This is not about buying the cheapest materials to cut overhead. These principles