GA 067 | Lean Dentistry with Dr. Sami Bahri, DDS

You're listening to episode 67 with Dr. Sami Bari, the Lean dentist. Welcome to the Gemba Academy Podcast, the.

Show that's focused on helping individuals and.

Companies achieve breakthrough results using the same.

Continuous improvement principles leveraged by companies such as Toyota Del Monte and the U.S. department of Defense. And now, here's your host, Ron Pereira. Hey there.

This is Ron Perera with Gemba Academy, and I'd like to welcome you to another edition of the Gemba Academy podcast. As always, thank you so much for taking time out of your day and your week to listen to the show and for watching our Lean and Six Sigma training videos over at Gembacademy.com we definitely appreciate each and every one of you. Now, today I'm recording this intro before I actually do the interview with today's guest. And this is the first time that I've ever done this. You see, normally I always do the interview, and then after the interview, I kind of see how it went and what we talked about, and then I go back and I record this intro. So what I decided to do today was, is kind of turn it around because I am extremely excited for Dr. Sammy Bari coming onto the show. Now, Dr. Barry is sometimes referred to as the Lean Dentist, and as you'll hear, he is a dentist in Florida who has been practicing lean for some time. In fact, he's spoken at many conferences, written a book, and he just got all kinds of knowledge and he's actually been doing this for quite some time. I first learned of Dr. Bari from Mark Graben. Mark has interviewed him several times over on his Lean blog podcast. And I was always intrigued and just really wanted to meet Dr. Bari and I've actually not met him face to face. Hope to one day, but I'm really excited to finally get to interview him. So the things that I plan to kind of explore with Dr. Bari is just really talk about how he first came to learn about continuous improvement. I'm really curious and I don't honestly know the answer if he was looking for continuous improvement or perhaps continuous improvement found him. So I just want to hear about his journey, how he gets started, curious how his staff took to it. I've been in a lot of different doctor's offices and I've got, you know, some healthcare professionals in my family and, and I can tell you lean thinking isn't necessarily top of the list with the way these, these folks are taught. So I'm really curious to hear how that's gone. And, and then I want to get us kind of talk about what's different between Dr. Bari's practice and say, a traditional dentist and just really super intrigued. So I hope you're going to enjoy the show. I'm sure it's going to be a good, good one. I don't know yet because I actually haven't done the recording yet, but we're about to. I'm going to interview him in about 15 minutes from now. Now, the last thing that I want to mention before we get to the show is that like last year, we are offering a 10% discount to anyone that signs up to go to the the AME Cincinnati 2015 International Conference. That conference is going on October 19th to the 23rd in Cincinnati, Ohio. We are going to be there and once again, we're media partners with ame. It's a great this is definitely my favorite Lean conference and really GEMBA Academy's favorite Lean Conference of all time. And so we hope to see you there. If you are interested in going to the conference, we can save you 10%. You'll want to use the coupon code Gemba15. So that's G E M B A15, no space, just Gemba15 when you register for the conference. Now, to make it easy, you can go to gemba academy.com ame and all the details that you need to register will be on that page. So again, just go to gembaacademy.com ame and all the details will be there. Now show notes for Today's episode with Dr. Bari can be found over at GembaPodcast.com 67 and that's 6, 7. So GembaPodcast.com 67 okay, enough from me. Let's get to the show. All right, Dr. Berry, well, thank you so much for taking time to come onto the show. Where are you calling in from today?

Thank you for having me, Ron. I'm calling from Jacksonville, Florida. That's where I live and that's where my practice is.

Home of the Jaguars, right?

That's right. Yeah. I'm calling you right after work.

All right, well, thank you again. I know you're very, very busy, so I really appreciate you taking time to visit today. So normally I always ask people to tell us about their background and whatnot. I'm going to kind of change it up and we're going to save that for the second question. But the first, just to start things off, Dr. Bari, we'd like to ask our guests to share a quotation that inspires them. So do you have one that inspires you?

Well, you know, depending on what time? You ask me, I have different quotations. It just happened that these days, what I'm discussing with my staff in the morning is a quotation by the owner of Starbucks. He said something like that. I might be missing a comma or two, but he said, we are in the people business serving coffee. We are not in the coffee business serving to people. And I think that's very profound. It is very profound because any service, and probably any manufacturing is in the people business. So when you go into a business and you see the people first, then everything else is serving them. So now here we understand it that we are in the people business, fixing teeth and improving smiles and removing pain. But it's really about how we communicate with the patient.

All right, excellent. Thank you for sharing that, Dr. Bari. Okay, so let's go ahead and start the formal interview here. And what I want to do is really just begin at the start of your journey. And. And what I'm most interested in hearing right now is how you first came to learn about continuous improvement. Specifically. Were you looking for continuous improvement or did continuous improvement find you?

It's a little bit of both, actually. When I came to the United States in 1990, I started my practice with two chairs, two dental chairs.

Okay.

And then little by little, we grew. Actually, we grew up very fast. We went from two chairs to five chairs, and I went from two assistants to five assistants. And I was really having trouble managing my employees, my business, and managing the patient treatment. So I started looking, how do people teach management and dentistry? And I studied pretty much everything that was out there. Still, after so many months, so many years, I would be working and patients would be waiting for me, assistants waiting for me. It wasn't working. Something wasn't working. So I had that friend. He was an MD Managing an operating. Not even operating an emergency room here at Memorial Hospital in Jacksonville. He was doing very well. He was. The time from ambulance to catheter was half of the national time. And everybody was happy with him. So I said, michael, how do you manage all of that? He said, well, there are those statistics. If you learn statistics and you have the voice of the customer and the voice of the process, and if you put those together, if you match them, you'll be fine. So I went and I bought a statistics book, and I told him, here, show me. Then he goes, no, that's not the kind of statistics. You have to learn something else. Well, obviously, he was talking about statistical process control. So that was the first thing we tried in the office. We tried it For a couple years, but I didn't have a lot of results at that time. I was studying everything I could put my hands on. We had a store here in Jacksonville where I could rent tapes. So I had tapes in my car constantly. I still do. As long as I'm driving, I'm listening to something, learning something. So I found a book one day, talking about a Lean Machine or something like that. And once I went to this bookstore, I was looking for that book, and I found a book called Lean Thinking. So I thought, that's probably the book I'm looking for. Let me listen to it. So I listened to it in the car, and in one of the passages, he says, I asked my daughters, why are you folding your mom's letter all at one time?

Yes.

And then moving them all to the envelopes, putting them in the envelopes, and then stamping all of them. Why wouldn't you do one at a time? They said, because it wouldn't be efficient.

Yes.

So I understood he was talking about something different. See, it took me back to where when I was in Lebanon, I was in charge of a dental school of the government dental school at the Lebanese University. When we started the clinic over there, I would go every day and look at the same patients coming one day for cleanings, one day for fillings, and for months I would see the same faces. So I thought, why can't we put every patient in the chair, get a specialist from every department, and get those people done in one or two days? But the solutions were so complicated that I gave it up and my team gave it up at that time. So here I am 12 years later, and James Womack in his book is saying that somebody had figured it out in car manufacturing. It was such a big shock to me that I had to stop the car. I went to the first parking lot, I stopped the car and started thinking, what can I do with this? This is exactly what I was looking for. So I went to the back of the book and found all those Japanese names like Ono and Shingo. And so I went to Productivity Press, that was pretty much the major publisher at that time. And I bought one book on every part of the Lean of the Toyota production system. Yes, I did not know at that time that Lean and the Toyota production system were the same. I did not know that I was studying the same thing, that it was the American translation. But I found a lot of parallel. Still, it made a lot of sense to me. Here I'm talking 1993, probably, and here in parentheses in the Book, it says muda. Look for Muda and look for waste. And I started looking for waste very actively. I was excited with my staff. We started looking for waste, trying to improve, and we looked for waste for 13 years with no improvement. Okay, that was very discouraging. I had studied Six Sigma in the meantime and around the year between 2000, 2003, I started going back to Six Sigma and seeing if I can find something there. And then one day I thought one piece flow. One piece flow is I, is what I found with James Womack. And I found that with oh no. And let me figure out what one piece flow means to us. And it took us a few months to understand that probably one piece is one tooth or one mouth. Then we adopted one mouth, one patient. We need to finish one patient at a time in 2006. So we're talking now, 13 years later, we figured it out. We knew that, okay, now we have to cross the barriers between the doctor has to finish the work and one appointment. Then why not the hygienist too? Why not the exam too? You know, we kept going back in the process until we tried to integrate everything in one visit if we could, if the patient's condition allows us. Right. So once we started doing that, we started finding problems. The first problem we found was that we had too many setups. If you want to set up for a crown, it's different from setting up for a root canal, let's say, or a filling. So we started working our setups. We studied smed single minute exchange of dyes, as Shingo describes it. And we were able to move from filling to root canal to crown, to whatever you call it without having to stop. And that allowed me as a dentist to do my part in one appointment if the patient wants it, obviously.

So let me make sure I understand. So I come into your office and I need to get a checkup. I haven't been for a while. I need a checkup and a cleaning. So I come in, they do a nice cleaning, you check my teeth and you say, oh, Ron, I'm so sorry, you had too many candy bars and you have a cavity in the back of your mouth.

Yes.

Instead of like today, my dentist will say, okay, go make an appointment and come back in three months.

Yes, yes.

So you're saying now do I get up and go wait in a waiting room and then come back and get my cavity or filled, or do you fill my cavity immediately?

Our goal is to fill your cavity immediately, but that's a true north goal. As you Know, in lean, you have what's called a true north, something you aspire to achieve all the time.

Yes.

But in our case, we're achieving that at 70%.

Okay.

So seven times out of 10, I am able to do it like right there.

Right. Right there after you look at it. Or do you have to move me to a new area and do some different, you know, I don't know, like, different setup or something like that. Do I have to wait or. It's now you just. You fix it immediately.

Okay. Well, you called it all first. First is quality without rushing. That's the goal.

Yes.

So if we can do it right there in the same chair without rushing anybody, without taking time from other patients, we do it right there, which is probably the case of 50% of the cases. Okay, then if I'm busy in the other chair, I give you a choice. I say if you waited half an hour, I could move you to the other chair and finish it. Right. If still we are too busy and I'm gonna jeopardize quality. I say maybe we can do it this afternoon. So you see, as soon as I can do it, I'm doing is not set in stone. The rule is not set in stone. The rule is a true north goal if the patient wants it. If the patient's condition, I can give you a whole list why the patient's could not have it. They're probably sick today. They're probably too weak. They're probably too young for it. But in 70% of the cases, we are being. Okay, let me regress a little bit. Okay. We have something that we call in our walkout. Flow or no flow.

Okay.

Which means have we been able to flow that treatment or not? Flow means that the patient condition did not stop us. Or we stopped because the patient said stop.

Today.

My system would have allowed me to continue, but the patient said stop. That is flow. So we've done everything we could by the patient's demand.

Yes.

No, flow is. If you ask me to fix your teeth and I say, I can't today, so I wasn't able to flow.

Yeah.

My system did not allow me to flow.

I wanted you to flow, but you couldn't flow.

Yeah. So we walk it out as we were not able to flow.

Okay.

And when we count those, we find that 7 out of 10 we are able to flow. But still in 3, 30%, I would say, I'm sorry, we're too busy today. We cannot do it. But that would be where our kaizen comes in. So we would say okay. What are the cases we're not able to flow and why? And every. We take every case and strive every day to improve. To improve our conditions to where we could flow more and more and more people.

Yes.

Is that clear? Yeah.

No, it does. It makes total sense. So one thing that you mentioned earlier that I want to kind of go back to is you talked about your staff. You know, you guys were looking for the waste and, you know, some success, but not. Not as successful as you'd like to be. I'm curious, though, in that very early phase of your journey, what. What did your staff think about Dr. Bari coming with all these crazy manufacturing tools and ideas and lean and Japanese words? And what, did they think you were a little crazy or what? How did that work?

Well, they probably thought I was crazy. I mean, they didn't show it that much, but I could guess a little bit that, yeah, here he goes again. But believe it or not, over the years, because it took us so many years, they were very familiar with the terms and very familiar with what Toyota was doing and why. I was excited about the Toyota production system, but I never called it anything. I never told them we have a system, and that's the lean system. We were just improving things, and I really didn't care about it whether it was lean or not lean.

Yes.

All I was doing was improving things for my patients. And then when people knew about me, we started having all those experts like James Womack and John Shook and Jerry Bussell, and, you know, we had so many people come to the office. Then the staff started asking me, why are these people coming? I said, well, you don't know it, but we're doing lean management. That's what it is.

Yeah.

And that's only 13 years after we started that I let him know that we are doing lean management. Before that, it was just trying to improve conditions. Now, I can answer some part of your question that could be very interesting to whoever is listening. I said, For 13 years, we didn't have any improvement, although we were removing waste, because I think we were removing waste from the old system. Okay, so if you like, it's like having a whole forest with some bad trees. And if you want to remove the bad trees, you're taking them out one leaf at a time. It's going to take some time. Whereas the real improvement was in changing the organization of the work. Instead of organizing it around batches of teeth treatment, like doing all the fillings at the same time, all the crowns at the same time, all the root canals. At the same time, we went into one piece flow that we called also one patient flow. I would take a mouth, sit in the chair, finish that mouth. So once we shifted to that kind of thinking and to that kind of practice, now every improvement, every kaizen is really going towards improving the one piece flow. And at that time we started seeing improvement. Like to give you an example, the waiting time of our patients was something like two hours, around one o'. Clock. So we were two hours behind. And I would apologize every day and say, I'm trying my best, there's nothing I can do about it. Two weeks after we started one piece flow, then the wait went down to 10 minutes.

Wow.

And then after one meeting, it went down to zero seconds. So now I could say probably 90% of our patients, if they're not early for their appointment, if they come on time, we ask them not to sign in, not to waste the time signing in, just go to the. To chair number five. So that's how dramatic the change was. So after so many years, and I'm talking many, many years of practice, you're taking your wait time from two hours to zero seconds right away. So that was dramatic.

Now what. But obviously you mentioned it earlier, quick change over smed. I guess you had to practice that and get that in place before you could do this one mouth approach. Isn't. Is that right?

Yes, absolutely. Yeah, absolutely. We had to understand what it means. We had to understand the processes. We had to understand that there is weight in the process itself. Some things we were preparing before the appointment, we thought, you know, maybe I can give you an example that everybody understands. Let's say I'm preparing for a cavity. While I'm draining the tooth, I'm going to take maybe four or five minutes to drill for, to drill and clean decay and all that stuff. So in four or five minutes, you can give me whatever materials I need for the next step. And when I'm utilizing those materials, you can give me the materials for the next. For the step, following steps.

Yeah.

So whatever weight we have in the process, we are using that and reducing the time that we need for setups.

Yes, yes. Internal, external tasks, right? Yes, that's right.

Internal, External.

Yeah. Okay. Okay, got it. Well, I guess my next question really is, and you've kind of touched on this already, of some of the differences. No waiting. That's a big difference. But what other examples differentiate your practice from as a result of lean thinking, from say, a traditional dentist who, you know, just came out of school and was taught classical Dental practices. What are the biggest differences between your practice and theirs?

You can take it from the employee standpoint also, you know, as far as employees, they are respected, Their opinions are respected. Over the years, I learned that whenever we have a problem, they can come up with better solutions than I can. It's not that I'm doing it because I'm generous. It's because every time I present solutions and they present their own, I find that they are closer to the work and they really are giving me better solutions. So they are very, very, very well respected in my practice. For instance, if today she needs to be out of the office because her son is graduating, all she has to do is put it on the schedule. Now, her responsibility is to make sure that there is somebody there to take care of the patients. So we're not going to have two people do it at the same time irresponsibly for their vacation. They just put it on the schedule. They don't need any permissions for anything. And those people have been with me for between 10 and 18 years, so they haven't disappointed me at all. Mm. One. One of the assistants went to another office, and she became a front. She became an office manager.

Okay.

And then she came back and she told me. She told me, as if as a receptionist in this office, I can make more decisions than I could make as a. As an office manager in the other office. So that's one thing. But I guess your question was from the patient standpoint, right?

Sure. Well, yeah, anything really, but that.

I mean, yeah, from a patient's standpoint, I think the most important factor is that we are on time. We are on time for the patient, and they can fill. They can put. How do you say that they can introduce that appointment in their daily schedule. What that means is before, when we were not on time, if you had some kind of cleaning in the morning, your whole morning is gone. Yeah. Because you didn't know how long you were going to wait. At Body Dental Group, Right. Now, if we say we're going to receive you at 12, you leave at 12:30. We receive you at 12, you leave at12:30. Actually, some lean thinkers here in the area heard me saying that, and they tested me.

Okay?

So I did not know them at the time. And the lady came from the DEP Here, Department of Environmental Protection. And after her appointment, she says, it works. Dr. Bari, I said, what works? She said, I left at the beginning of my lunch break, and here I'm going back before my lunch break is over.

Wow. That's amazing. I don't know if I could ever say that about any office. I saw a dentist, doctor, anything, doesn't matter. I don't know if I could ever say that.

That's right.

That's amazing.

But let's analyze it as lean thinkers.

Yes.

Right. Being on time, to me, all it means is that you're functioning below capacity, you know, so functioning below capacity means either that you have too many people or you have squeezed the work so much that the capacity that you have can handle whatever work you have. So I think when we went to one piece flow and continuous improvement, then we continuously increase our capacity with the same number of staff that we have, and that's how we are being able to receive those people on time. See, it's always a positive thing. But as a business owner, I'm always thinking that here I am functioning below capacity, so maybe I can see more people. Does it make sense?

Yeah, no, it does. I mean, obviously, I mean, I was thinking, I mean, you're a for profit business, obviously, so, you know, sending a person away to, say, come back in three months to have your crown or whatever, maybe they don't come back, you know, Whereas if you keep them in the office and they're all, okay, let's just do it.

That's right.

That's more. It's more cash. Right. Let's be honest. Right?

It is, it is. And it's. It's fewer steps.

Yes, yes.

Example, in the first year of the first year alone, we are three dentists and three hygienists. We saved 1800 appointments.

My gosh.

For the same amount of dentistry, we did it in 1800. Fewer appointments.

Wow.

So one of the Doctors told me, Dr. Bari, your system is wonderful for you, but I'm spending most of my time surfing the Internet and looking at my email. Either I need more patients or we need to find some way to improve your system.

Well, it's kind of like the classical theory of constraints. Right. And the goal. Right. The constraint now has moved outside of your building. Right. And yes, now that's a great problem to have though, you know, to bring more work in.

Yes. Now, when we. When she looked at the numbers a month later, she found that she was producing 35% more every appointment. And she alone saved 800 appointments during that year. Which means that if somebody called her, she would be able to take him right away because she has all that time on hand now. And that's what waste removal is about. Right. Freeing up capacity.

Yeah. Yes. Yes. Wow. That's Amazing. I need to come and visit you, Dr. Bari.

I would love to show you around.

Yes. I think maybe we talked about this earlier. I think we need to come and do a. An official Gemba Live. We'll bring our video crew in and you can tell your whole story on video.

One condition, though. You give me improvement ideas.

Oh, yes, definitely. Definitely. You know, let's see. One other question I had. So. So far we've been talking about dentistry. Do you also do anything with, like, orthodontics and braces and stuff like that?

My brother does that.

Does he practice lean?

Yes. Yeah.

I'm curious.

He does it his own way.

Yeah.

My brother teaches for two days at a university, so he's not here as often as I am, and he has to accommodate his schedule of teaching, so he's not here 40 hours a day like I am. I can level the work much better than he can. That's one of the factors that makes it easier for me.

Yeah. And I guess then orthodontics is slightly different in that there's only so much you can do, Right? I mean, you can put them on and that's it, right?

That's right. And their adjustment time is so much shorter. So he can see 90 patients a day where I can see more than a handful.

Yeah, yeah, yeah, got it. So the last question I have for you in this section, Dr. Bari, is, let's say there's a dentist listening to this podcast right now, wondering how, you know, he or she can do this. Once you speak to that person, what advice or wisdom can you share with them?

Well, I can. First. First, I would like everybody to know that whatever management systems we have in healthcare, including dentistry, comes from manufacturers. It comes from when Gilbreth started teaching people about motion studies and when Taylor, I think, started time studies. So learning from manufacturers is nothing new. We have to learn from them because these are the people investing in research about management.

Yes.

The Toyota production system that we call Lean is the only system I know that has taken a company from being a small rural company in Japan to become either number one or number two, depending on your position in the world. Now, you can find on the market so many management systems, but none has the record of taking that a company from small to number one.

Yes.

And I have. I've been lucky to find that system and to find a way to apply it to dentistry. So I think there's no doubt it works. It works. It works very well. And I really encourage people to find more about it, either through my book or our Video or if they want to do some research for themselves. There are so many resources like Gemba Academy. You can have, I don't know, 2000 articles or something.

Yeah, we got a lot, a lot of videos, a lot of articles. Yes.

Yeah. The main thing is to know that Lean management is the modern way of managing.

Yes.

It gives you much better results than the old way, which is batch and queue.

Yes.

And I think it's worth it for any business, not only dentistry.

And I apologize, we should have mentioned your writing earlier, but tell us a little bit about your book quickly.

Well, my book is about actually leadership. It wasn't geared towards dentists specifically. Yes. Because I was asked by people who deal with manufacturing to write a book on leadership based on my experience in transforming my practice into Lean. So it was the Lean Enterprise Institute. And actually they tricked me a little bit into writing the book. I shouldn't call it trick, I should say coaching. Okay. So they said, write everything you know about your professional life. So I started writing everything. Every night I wrote something like 300 pages. But then they said, okay, we're going to look into that. And then a couple months later, they said, that's going to be the book. They organized it into chapters and sections and they started asking me questions, when did you do this? Why did you do that? And once I answered all the questions, they said, okay, now we're going to write the book. So a few weeks later, they called back, they said, no, we're going to keep your voice in the book. It's going to be the way you wrote it, but we're going to adjust the style a little bit. And they edited the book.

Yeah.

The goal was to have a 60 page book. Because my criticism of Lean books is that they were not leaning. Yeah.

Yes.

So you would have an idea on page number one and the next idea would be on page number 10.

Yeah.

And in between, it's a lot of explanation. I agree. But it would be very hard for someone to follow. That's what these people want. Yes. Because I know it for myself. I read so many of the books and I had to look for ideas and they were far apart. Yes, that's one thing. The goal was to reduce it to 60 pages and it's now 80 pages, 88 pages with all the pictures and the glossary and all that stuff. Yes. The second idea was to have a video to complement the book. So whatever we could put in writing, we wanted to put in writing and whatever was best communicated in audio, visual. We wanted to have a cd, a DVD for it. So we did the DVD with Bruce Hamilton and gbmp.

Yes.

And now both the book and the DVD are sold at Lei and GBMP and Amazon.

And the title is Follow the Learner, correct?

Yeah, it's Follow the Learner. It was Michael Brassard, the editor at that time. He stayed with us, and he saw how we were always learning all the time discussing stuff together. How we would stop each other in the hallway and say, this patient didn't flow because of this or that. And how my assistants would stop me in the hallway and say, Dr. Bari, you've been late for that patient. You were three minutes late.

Yes.

So we would learn how to improve that. So he goes, ah, Follow the Learner. That's going to be the title of the book.

Love it.

Love it.

Very good. All right, well, Dr. Bari, thank you so much for that. I can't wait to come and visit you. I'm definitely want to come. So let's talk about that offline. But the next section here of the podcast is what we call the reflection section. So this is as. As we touched on before we started the interview, it's where we kind of just kind of go through some questions that we ask all of our guests.

And.

And the first one is, as you know, when you're studying TPS and lean in general, we spend a lot of time talking about kind of the pillars, continuous improvement and respect for people, with continuous improvement being a little bit easier to define the tools, the techniques, methodologies, but respect for people, sometimes we all recognize and agree it's important, but it's kind of hard to put your finger on. What exactly is respect for people? So I'm curious, what does respect for people mean to you?

Okay, well, first, people is everybody.

Yes.

When you say people, it's everybody.

Okay.

It's not that I'm here with my staff saying we need to respect people, meaning patients. People is everybody. Today we were mentioning a book that says the customer comes second. And I know his meaning is the employee needs to come first because these are the people creating the systems, and those are the people respecting the patient. But today we were discussing what the customer is. And as you know, Dr. Deming said the customer is the next person who. Who is utilizing your services.

Yes.

So we said if the next person utilizing your services is your colleague, then 100% customer satisfaction means your colleague needs to be 100 satisfied with your service. So that. That's one aspect of it where we are really mindful of who is going to utilize our service. Next. Now, respect for people, to go back to your question, means that we really look at the team and we see people helping people, and their input is respected, their private lives are respected. People say, keep your problems at the door. I say, if the problem is small, you don't need to ask me. I'll leave it at the door. If the problem is big, no matter how much you ask, I just can't leave it at the door. So our job is to help each other whenever we have a big problem. That's part of the respect for people. Second part is to create an environment that is safe for experimentation. And I'm not saying experimentation. Try to drill into the nerve and see if the patient is going to hurt. As long as it's safe for the patient. If you want to place the instrument here instead of there, you know, I would let you do it. I would. It's welcome. It's not that I'm letting you do it. It's the rules of the game.

Yeah.

You want to experiment with something? Yeah, let's experiment with it. Today. It didn't work. Well, let's see why. So experiment. Experiment. Small experiments should be allowed and people should be allowed that creativity in the practice. Their opinions about how the practice runs needs to count. Not only about their job, they need to have an input in everything, all the direction that the practice is taking example, just to make that tangible. One time the front desk person said, people are calling for that kind of whitening and we are really charging so much. We're charging too much for the area. I said, what do you think? She said, I do think we're charging too much. I said, how much do you think we need to charge? She said, I don't know at this point, but I can research it for you. So she went back and researched it and she changed the price herself. She didn't have to come back to me, you see, So I am just part of the team. The hygienist, for instance, if she sees, she acts as a quality control for us. If she sees something I have done in the past that is not up to standard because we want everything to be perfect for our patients, she has the prerogative to go and make an appointment for me to redo it for free, she doesn't have to ask me. She says, doctor, we did that two months ago. And although we take X rays before people leave, you know, you always. There's always little mistakes here and there. So she. She just does it. She says, Dr. Bar is going to do it for free. So I don't know if I'm asking your questions.

Yeah, no, no, it's good. I mean, you focused, obviously, a lot on your staff and, and how you empower them and sounds like they have lots of autonomy and, and freedom to. To move. And so I think that's a very beautiful and classic example of respect for people at its best.

Yes. Because, you know, the patients, we always have a stake into respecting the patients. And those are people. The people paying us.

Yes, yes.

So there's always a direct interest, a financial interest.

Yeah, for sure. For sure.

Yeah. There's always the professional part. You have to be professional. You have to be courteous.

Yes, yes.

But on the other hand, those people are not staying with you for 18 years.

Yes, exactly.

So it is easy to respect them and they're going home. Never become deep in relationships as. And obviously I'm saying professional relationships.

Yeah, yeah, yeah, for sure. Dr. Pari, what's the best advice you've ever received?

The best advice I've ever received.

Yes. Could be from your grandma, your.

Oh, it doesn't have to be me.

Yeah. It could be anything. Just your whole life. What's the best advice you've ever received?

Okay. The best advice I've ever received. I mentioned that in my book, actually. I'm going to give you two best advices. Okay.

Yeah, yeah. Your best and best.

This first one came from my uncle. My uncle was on his deathbed and he had been very stubborn all his life in my eyes. So I've never seen him change his position. He would argue. He would raise his voice if you go against him. And then when he was very sick, he was telling me stories about his life. He was looking back at his life and he was telling me how flexible he was. And I laughed. I mean, I laughed out loud about his flexibility.

He says flexible, like his limbs were flexible, like his arms are flexible.

Or mind flexible.

Oh, okay.

Mind flexible. Stubborn. But mind. He was saying that his mind was so flexible. Okay, okay, I'm sorry about the confusion. Yeah, so I left out. I laughed. How can you say you're the most stubborn person I've ever seen? And you're saying you're flexible? He says, well, convince me and you will see whether I'm flexible or not. You want me to be. You want me to change the way I think without convincing me. But convince me and you see that I will defend your ideas. So from that moment on, I've never asked people to trust me. I have to provide proof. So if people don't ask for it, I go in a more subtle way, and I provide proof. The second one was from my older brother. My older brother is an orthopedic surgeon here in Jacksonville. And I was really annoyed when cell phones came up. How people are always on their cell phones, and they go and call their husbands and they call their sons, and they. I said, I don't know, I need to find a rule for those cell phones because they're spending. They're calling their family on work time. He said, but those people have families, right? I said, yes. He said, do you want them not to think about their families when they're at work? They have to call their families. You need to allow them to call their families. So that also caused me to change all the way. I'm thinking about how I'm dealing with my employees. It's not only about who is on my clock, who is on their clock. It's about really taking the whole person and showing respect for their entire life. Entire person. Not just the person who is here serving me on the clock.

Yeah.

Yeah.

That's wonderful.

Yeah. Those are the best two.

All right, so next question. Do you have a personal productivity habit that others might benefit from? I'm sure you have many within your practice, but I'm curious. Do you yourself have any personal productivity habits that you leverage?

You mean to be more productive?

Yeah, just at a personal level, you know, like an email hack or something like that. I don't know.

At a personal level.

Well, you know, I mean, at your work or something like that. But, like, for an example, might be I use Evernote to file all of my documents so I can research them later, or something like that. That might be an example. Something like that.

I don't know if you call it productivity, but it's about learning more than productivity. The practice I have adopted since I left college was to take a book every night and then read enough until I get to a point I can apply the next day in my practice. And when I'm reading, I highlight with, like, the traffic lights.

Yeah.

Red would be avoid that.

Okay.

Green would be. This is a practical advice that you need to apply in your office. And yellow would be just pure information that doesn't advance the practical part. But this is information that you will need.

Oh, I love that. That's a great idea.

Yes. So every night I need to get to a green something that I will come fresh in the morning, and I say, we're going to try that.

Wow.

So it could be something about management. It could be a new product A new adhesive, let's say we're trying, that would reduce sensitivity. It would be a new product that makes surgery easier. It could be something that would make the root canal easier. But every day when we come to the office, there is something new that we have learned and that we are using to improve the service to our patients. Yeah, so if I have any habit, that would be it. Now, from the productivity standpoint, it's really first for the products. The location of the products is extremely important when you want to work, so the location is very important. Second, the one piece flow is really like a religion now in our office. And the third would be for leadership. I haven't found any advice better than go see ask why. And what is the third one? Show respect. Yeah, right. Go see ask why. Show respect. Every time I try to solve a problem from wherever I'm sitting, I could be in my office, in the dental chair, in the lab. If the problem is not there and I try to solve it with people, we never come up with the right solution or with something adequate. But when we go and say, show me how it's happening, then we can arrive to better solutions. You know, Shingo says if you can't reproduce, if you can't find out how it happened, try to reproduce it. Try to make a mistake like that and you'll probably find out.

Yes.

So I haven't found any better advice for leadership.

Yeah, probably. I don't think there is any. So you don't have to look. All right, last question I have for you is, is there one knowledge or skill area I would say related to Lean thinking that you need to improve on in order to become better at practicing Lean?

Yes, there are tons I need to improve on. But you know, we applied Lean before value stream mapping, so we haven't done any value stream mapping.

Okay, well, I'm going to set you up with a subscription to Gemba Academy and as a guest you get free access here. So I'm going to set you up and then you guys go in there, watch our transforming your value streams course and then we're going to come and videotape all of the good work that you did. How's that? That's how you pay us back.

Perfect. Perfect. The second thing we're trying to perfect is visual management. Yeah, so we're trying to see. We have worked a lot on visual management.

As I was going to say, I've seen a lot of articles that you've written and you've done a lot of work already.

Yes, we Have. But I'm trying to make the service visible because in service, the big hurdle is that you can't see what's happening. You can see the progression of service. You can see how much has been done and how much is left. So we're trying to make the service visible, and we're working a lot on that these days.

Beautiful. Oh, wow. Tremendous episode. Thank you so much, Dr. Bari, for taking time. I know it's late in the day there for you, so I really appreciate you taking time to visit with us. Let's just wrap things up with you, sharing some final words of wisdom. And then why don't you tell people how they can connect with you, Perhaps with your website or email address or something like that.

All right. Words of wisdom. I don't know if I have any, but I can tell you practical words.

Okay.

Practical words. And I want to say that continuous improvement without flow can lead nowhere. Really. Or let me not be absolute like that. I would say continuous improvement without flow has not led to any improvements in our overall operation.

Wow.

So flow needs to come first, and then you start doing continuous improvement on that flow. Obviously, if you do continuous improvement in whatever system you are in today, you are going to find small improvements and you're going to rejoice. But I can guarantee you those are very superficial improvements. The improvements we have found are only after we shifted to one piece flow. That's analyzing waste. If you're not in one piece flow is a waste of time itself.

Yeah, well, yeah.

I mean.

And one piece flow just elevates any problems that you do have. They just come straight to the top and you're forced to deal with them. Right. I think absolutely. To me, that's the power of one piece flow. Not that it's easy. It's very hard.

It is hard.

Yeah. But once you've got it and you're working in it, you can never go back.

That's right. But I'd rather work on hard work that. That's given me results.

Yes.

Rather than working on hard work that's giving me frustration.

Exactly.

All right. To contact me. And I would love people to contact me on my email@sami samiaridental.com Bari spells B A H R I sammyaridental.com yes.

Beautiful. All right, well, thank you again, Dr. Bari. I can't wait to meet you in person and visit your practice and maybe I'll put you to the test. You give me a checkup and I'll. Maybe I have a cavity and hopefully. And then you can fill it. No, just kidding.

All right, just tell me when so I can sharpen my instruments, okay? Okay.

All right. None of that nerve experimentation, though, okay? I don't want any of that. All right, well, take care, Dr. Pari. Thank you again.

Thank you, Ron. Thank you for receiving me. Thank you. Bye. Bye.

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