55: Going to GEMBA Gets the Best Results

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When I was working as an associate rat at a school, I never imagined I could own these many practices with this amount of support. So thank you.

You have helped build my marketing mind to a whole new level.

You have this natural talent, this unique ability. Hello, everyone, and welcome to another episode of DSO Secrets. I am Ken Kaufman, your guest host today, filling in for the illustrious Emmett Scott. Some of you will know or remember this, I work with Emmett every day as the Chief Financial Officer at Community Dental Partners. Now, as I'm filling in for him and with the short time that I have with you, I wanted to share a real life problem that we started to run into at Community Dental Partners. How we overcame it, and how this thing called Gemba was the key. But before I define Gemba, let me explain this one situation which could be extrapolated out to lots of places where we were struggling in the business.

So

we had found with rapid growth, and this is common, that our culture, our value system, which we call our nine pillars, they had suffered with rapid growth, with de novos and with acquisitions and just with a growing business. And we were finding that there were lots of employees who'd never heard of the nine Pillars. There were lots who didn't understand how to utilize those nine pillars and what they meant to the whole core culture of our business. And we knew that it was going to be hard to develop out a business that had a strong culture that would drive great patient experience, great staff experience, and great doctor experience. It would just be impossible without making sure that we had a consistent scalable platform to make sure that our culture was represented and present in every single employee. Notice I didn't say location or business unit or department. We need the culture to exist in every single employee. So what we were finding was we had all these employees and they weren't familiar with the culture, didn't understand our value system and what we call the nine Pillars. And as we thought about it and we brainstormed, it was especially myself and our coo, Jody Evans, and an idea started to form that, hey, we actually have a platform called Our Morning Huddle, which as the COO of the business and on the operations side, Jodi and her teams had spent quite a bit of time revamping the morning huddle process and really building it into a nice scalable system that was occurring in all the locations. And it wasn't run exactly the same, but it was run based on the same core set of principles and had some of the same things that were being talked about. And so in our brainstorming around how do we solve this culture issue and getting it to scale through the organization, we realized that the daily huddle was gonna be the perfect platform to be able to do it. And as we were talking through these ideas and I started to brainstorm with our HR team, here's the problem that I found very quickly. No one on this team, who was responsible for, who is in the organization responsible for developing and protecting and writing for the brand of the CDP culture and the nine Pillars, nobody in this department had ever worked in a practice. None of them had spent any time actually being in a morning huddle and seeing how that works and what happens if a patient shows up early and all of the nuances that go with this. And so I found when we started to talk about it, there was a whole lot of assuming and a whole lot of speculation about what may or may not be a good idea, but nobody actually knew. And the reason why is because they had not been to Gemba. Now let me take a second and define what Gemba means. This is a Japanese word. You recall, the Japanese carmakers started to take over and dominate what had been US dominated manufacturing of automobiles up until the late 70s, early 1980s. And then the Japanese concept of kaizen started to show up. And all of these foreign made vehicles were coming onshore and beating in terms of quality and price, what was being developed onshore. And you know, if you look at GM in the 1950s, 1960s, they were on an unstoppable machine and they started to struggle. And this Kaizen concept, which there's the Six Sigma and all of these different initiatives that have come off of it, Kaizen means constant improvement. You're constantly finding ways to improve and to make things better and make things more effective and more efficient. One of the key principles within the Kaizen concept, and there's lots of books out there you can buy and read about this. Let me just give you my summary and how I understand it and how we've implemented in our business. Gemba represents in Japanese the word actual place. If you ever want to try to figure out how to improve something through a Kaizen system or do any type of problem Solving through a Kaizen system. You can't do it in the ivory tower. You can't do it off in some conference room. If the actual functions that you're talking about are happening on a shop floor somewhere or for all of us in the dental business are actually happening chairside or in a waiting room or in an exam or x ray room. So when you take all that into consideration, Gemba is the actual place where things happen. And you have to go to Gemba, understand Gemba, meaning what's actually happening at the place, and build solutions that are going to add value and improve whatever is happening at Gemba. That's the whole point. It can't be pontificated upon and dreamt up in some ivory tower in some other building or conference room somewhere. The truth is at Gemba and you have to go to Gemba. So here I am sitting in this room. We're thinking about how can we use the platform of our morning huddles to drive the message of our culture and our value system and to get buy in throughout our entire organization about who we are and what we value and why we value those. And I didn't have anybody in the room who'd ever been in a morning huddle. None of them had even worked in a practice before. And some of you are probably experiencing this with your multi group practices or even DSOs where you are hiring people that haven't worked in a dental practice before because you need accountant, an accountant, not somebody who's been a dental assistant. You need an HR professional, you need IT people or professionals. And so really quickly as I started to see this and realized that we were just going to completely miss the boat without going to Gemba. We would have developed a program, rolled it out, nobody would have used it because it would have been garbage because the people creating it didn't understand what was actually happening at Gemba or in the practice at that morning huddle. So here's what we did. We took one of our employees actually as a result of this, I actually sent all the employees out in the HR department to go and visit practices and meet with dental assistants and just ask to observe and watch and see what they do every day in their business and you know, just in their daily tasks and activities and how things work and what the processes and flow are and some of the challenges that they come up against. At a minimum, Gemba creates empathy for your staff. I'd highly recommend. Don't let your ivory tower, your support people that are away from the practices, don't Let them be too distant. I'd encourage you to encourage them to be at Gemba, or at least experience it and understand it. What was interesting is then the HR employees came back, and they had so much more empathy for what was happening at the practice, and they were far better able to serve them as different needs and challenges. We're coming up, and it even spills over to today. We still are reaping the benefit of this initiative, but specifically around the culture and driving that through the platform of our morning huddles. We sent one of our employees for a week. He had to go each morning he woke up and he drove to a practice, and he sat in on their morning huddle. And he was there just as somebody from the support center that was just there to observe and ask questions and just kind of observe how morning huddles work, because he's a new employee, and he wanted to learn. So he went and did this, and it was so powerful because he came back and he explained how he watched practice managers work within the context, in the framework of the morning huddle and consistencies and some inconsistencies, which you'd expect. Leadership is always going to be a little bit different. But we saw, and he reported back that the key principles that our operations team had worked so hard to develop, that those were being followed, and those were being adhered to, and those were being emphasized within the structure. And we then said, okay, now with all that information and what we understand about Gemba now, how would we build something that would fit into that morning huddle system? And we did some more brainstorming. And what we did was we actually came up with a sample of what it might look like, and we batted it back and forth a little bit. And once we felt like we had something that was potentially worthwhile, rather than roll it out to the whole company, what we did was we had this employee actually pick one of the practices where, you know, as a practice manager, that would be comfortable trying out some new things and brainstorming a little bit. Not somebody who'd be overwhelmed by us throwing something new that was gonna change through multiple iterations. Well, we got it right. We found a practice manager that would be flexible and have some quick start to their personality. And we had this employee go and we developed five days worth of what we call nine pillar activities or value activities. And we said, now go to that practice each day and just give the information to the practice manager and just observe what happens and see how everybody responds to it and see what takes. And it was focused on one of the pillars, and each activity was focused on creating a discussion or some type of an activity that would be very brief, say five minutes or so of their time in the morning huddle to have this pillar focus or this value focus. And he went and he did this and he came back and it was so powerful. Again, it was only because we went to Gemba, where truth was, and he said, oh, wow, this part worked great. This part didn't work so well. Got some issues over here. Got great feedback on this. These employees over here were so excited about this part of it. And this is why we had all this amazing feedback. We iterated and iterated and kept going back with each iteration to see how the morning huddle system and process would support it and how it would work. And until we came up with the final product, we launched the final product, we had immediate adoption throughout the organization. We had practice managers and managers throughout the organization asking for more, asking questions, needing help and support on things. And it was a very proactive initiative that everyone wanted. They saw that it was going to help and they understood the value of it. I recorded a video and sent it out to introduce it. Emmett recorded a video of himself. We tried this thing, we were trying to be kind of millennial, I guess, where we were doing selfies of ourselves, walking around, taking videos, just talking about the nine pillars and our values. And we why the pillar program, which we ended up calling pillar in a box, why it would be so important and why we were inviting them to engage in their morning huddles around this concept. So we did some marketing and some good focus around it, and it has exploded and it has basically built a life of its own. And it is a part of every morning huddle that happens throughout our organization. But the only reason why it's successful, the only reason, is because we went to Gemba, because we went to where truth was. We went to the actual place and we figured it out. So there you have it. That's what Gemba is. It's how you use it. It's how you ensure that you're delivering value to practice staff, to the dentists and to their patients. Now, perhaps, maybe sometime down the road, I can get into a little more detail about exactly what you do at Gemba, how you roll up the shirt sleeves. Because there can be a right and a wrong way to go to Gemba. If you show up as a bull in a china shop, that's going to create a whole bunch of issues and problems. There's a right and wrong way to approach it. But just remember, anytime you find yourself in a conference room or somewhere away from what it is you're talking about, what you're trying to solve and what you're trying to improve, stop the conversation. Have the courage. Stop the conversation and encourage everybody. Hey guys, let's make sure we get to Gemba. Let's make sure we understand what is really actually happening and why it's happening that way and what's driving. What are the underlying drivers of how all this is working. Because as you understand what's happening at Gemba, all of a sudden you're going to be able to create and develop things that aren't going to sit on a shelf in a binder, but they're actually going to get implemented and they're going to drive huge improvement through your organization. Well, it's been a pleasure to be with you. Don't forget to join the DSO Secrets Facebook Group. I love this group. Emmett's built a great community for everyone to interact and share ideas and ask questions and answer questions and it's actually been a very respectful group for which I'm very grateful and appreciative of as people are brainstorming and trying to figure out how to take the next steps and how to improve their multi group practices or their DSOs. Again, encourage you to join the DSO Secrets Facebook Group. Just search for DSO Secrets and request to join and Emmett or one of the other admins will get you added as soon as they're available. And as we part, I always have to part in the way that Emmett does. Until next time, keep smiling.

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