Very Dental Extra: Why Choose a Lean Workflow? with Kate Reinert

[00:00:00] This is a production of The Very Dental Podcast Network.

[00:00:11] Sometimes you just can't get enough very dental.

[00:00:14] Sometimes you need a little bit more.

[00:00:16] Now is one of those times.

[00:00:19] Welcome to The Very Dental Extra, very dental people welcome to another episode of The

[00:00:25] Very Dental Extra.

[00:00:27] So this very dental extra was brought to us by our friends at Zirk and I'd like to introduce

[00:00:32] you my co-host Kate Reinerd.

[00:00:35] She's from Zirk, Kate, how are you doing?

[00:00:36] I'm fantastic.

[00:00:37] How are you doing today?

[00:00:38] Good.

[00:00:39] So we've done this before and we have had several requests to dig a little deeper into

[00:00:45] oh some of Zirk's concepts about the color method, lean workflows, that sort of thing.

[00:00:51] And I guess I'm going to start with what is your role at Zirk?

[00:00:55] Like on a day to day basis, what do you do at Zirk?

[00:00:58] That's a great question.

[00:00:59] Thanks for asking.

[00:01:00] So as a clinical efficiency consultant it is my focus and my role to help dental teams understand

[00:01:07] the importance of lean clinical workflow, lean clinical efficiencies.

[00:01:12] And I do that by helping them identify any efficiencies or barriers in their work day.

[00:01:19] As I go through that process we talk a lot about their current practices, their current

[00:01:24] operations and how they have navigated that so far.

[00:01:29] And then we let them talk to us, let them let out what their pain points are so that

[00:01:34] we can make sure that we are addressing them in our new clinical system that we're implementing.

[00:01:39] Okay, so how do you come into their clinical work?

[00:01:45] I'm curious because I think Zirk probably has several ways that people can use their

[00:01:51] system but like let's just say someone is all in wants Zirk to do everything and does

[00:01:56] kind of the high end consulting thing.

[00:01:59] How does that work?

[00:02:00] Do you actually see them work?

[00:02:01] Do you go into their office and watch them do things or do you have how do you gather

[00:02:06] the data to know, you know, because if you ask me what my pain points are, I'm sure

[00:02:12] I can tell you some, but if you ask my assistants what the pain points are, you probably

[00:02:17] hear different ones and maybe they're all valid but the reality is that my suspicion is

[00:02:23] depending on who you're asking is who you'd run into or a hygienist who's running at

[00:02:27] a completely different.

[00:02:28] So the question is how do you see this and how do you get this information?

[00:02:31] So the way that we get started with practices is they're looking for a solution, they know

[00:02:37] that they have any efficiencies and they want to improve their current practices so they

[00:02:40] reach out to us.

[00:02:42] The first steps that we have with them number one is training, we want them to fully understand

[00:02:47] what the system looks like and how it operates.

[00:02:50] The more people we can reach with to and connect with at the practice, the more successful

[00:02:55] the practice is going to be with implementing this system.

[00:02:57] So that step number one is comprehensive training so that there's full clarity across the

[00:03:01] entire team for how the system works.

[00:03:04] The next thing we do and I like to consider it as we find a champion within the practice

[00:03:09] that's going to help communicate back and forth with us in this pre-planning phase.

[00:03:15] Maybe that usually works closely with the doctor, good communication, open communication

[00:03:19] with them and you know the office manager who's going to be helping make some of the budget

[00:03:22] decisions.

[00:03:24] And we work with them on getting what the practice operations look like so they will help us

[00:03:29] determine what procedures they provide and in what volume they give us a lot of data when

[00:03:35] it comes to how many instruments do you have for each procedure?

[00:03:39] What materials do you have?

[00:03:41] They're the champion that are going to help us get all of that information.

[00:03:44] They take a bunch of photographs for us and send that to us.

[00:03:47] That's critical information that we're looking for because on the front end of that white

[00:03:54] glove service that we're going to provide for them is all of that data capture.

[00:03:57] And we want to have like I said, a champion of a team member that's going to be able to provide

[00:04:01] us with that as efficiently as possible so that we can keep the ball rolling for them.

[00:04:06] Occasionally we'll run into barriers where they're just a really busy practice and we

[00:04:10] need to keep moving along in the process.

[00:04:13] And sometimes we have to hand the baton from one champion to another but really capturing

[00:04:18] all that data on the front end so that we can come back to them with a proposal, a recommendation

[00:04:24] on what product are we going to be ordering and what volume some what quantities.

[00:04:29] That's what we want to provide for them because it's such a challenge for them to stop

[00:04:33] what they're doing which is seeing patients.

[00:04:36] That's what they're doing.

[00:04:37] That's what they want to do.

[00:04:38] That's what they do best.

[00:04:39] So we do all that on the back end for them, providing them with that proposal.

[00:04:44] So all they have to do is cross-reference it with what they're doing.

[00:04:47] Is this going to work for us?

[00:04:49] Isn't it should we increase this quantity or not?

[00:04:52] And then then we get to go into the practice and work with them.

[00:04:55] So again, that white glove service is where we go in hand in hand shoulder to shoulder

[00:05:01] implementing the system with them.

[00:05:03] We give, we dedicate an entire day to the practice where we have created like a planogram of what

[00:05:10] the day is going to look like.

[00:05:11] We take sticky notes so we put it on different areas of the practice so that we can identify

[00:05:17] what's going to go in these spaces and really map out what that implementation is going

[00:05:22] to look like for them.

[00:05:24] And then we do it with them.

[00:05:25] We go in and we do this work with them.

[00:05:29] And then we wrap up the day when we're finished.

[00:05:31] Again, we finish off with a comprehensive training again.

[00:05:35] We want to make sure that everybody in the practice has full clarity on what the system

[00:05:40] looks like so that we can leave and know that they understand how the system works.

[00:05:48] And they're going to be able to keep it intact once we do leave.

[00:05:51] I mean, that's one of the things too that like like so often when you try and implement

[00:05:55] new things.

[00:05:56] In my case, I think about like procedures or if I take in a class or whatever.

[00:06:00] For one thing, a lot of times if one person or a couple people are kind of understanding

[00:06:05] it but lots of, but the whole team isn't then it's a problem like that's so you're saying

[00:06:10] you work with the whole team and you you're literally sitting there in this particular

[00:06:14] case you go in for a day and you basically run through a schedule showing them how the

[00:06:18] system works.

[00:06:19] So everyone is involved.

[00:06:22] What things do you have to do to make sure that it is maintained because change is

[00:06:26] hard.

[00:06:27] Change is hard and everyone's got to be really committed to it but what things do you guys

[00:06:30] do to make it so it's easier to keep those changes in place?

[00:06:34] We, when we leave the practice, we can only control what we control over there.

[00:06:40] When we leave the practice, we set up a four week follow-up call or webinar with them

[00:06:46] and in those four weeks, we ask them to keep the system as it is.

[00:06:51] Don't make any changes.

[00:06:53] Don't regress back to the way that you were doing things because in four weeks, we're

[00:06:58] going to talk about those challenges.

[00:07:00] We're going to talk about what did you face in barriers, in challenges, in things that

[00:07:06] just aren't working and then we're also going to talk about the successes that they've

[00:07:09] had.

[00:07:10] I had a call earlier today that encompassed all of that information and I hear the

[00:07:15] same things over and over again and we have solutions for each of them.

[00:07:20] The biggest thing is making sure that everybody on the team has full understanding of how

[00:07:26] the system works and then just ask them to keep it intact for those four weeks.

[00:07:31] Once we get to that four week timeframe, that's when we can start to uncover some of

[00:07:36] those barriers that they might be having and then help them understand ways to pivot or

[00:07:43] even give them additional clarity on how the system is supposed to work.

[00:07:48] Maybe it was just a miscommunication or misinformation that they didn't understand

[00:07:52] on the front end and reinforcing it on the back end can help them understand that, oh yeah,

[00:07:56] I guess this is the reason I want to keep my tubs next to my trays and so on and so forth.

[00:08:01] Let's pretend that I'm in an office here who's at the front end of this and we have collected

[00:08:08] data about what we're doing now so that that would include photos of setups probably

[00:08:15] photos of the opportunities in the way that we have the setups in the opportunities.

[00:08:19] Maybe photos of an opportunity after we're done to see where things ended up which is

[00:08:24] reality and then maybe photos of cabinets or no cabinets or whatever they have in the

[00:08:32] current system so that you have an idea of what's there.

[00:08:35] Do they ever take, do you ever have people take video of someone standing inside

[00:08:39] take video of how they're actually working because we have smartphones so we can do all

[00:08:43] this stuff without too much hassle.

[00:08:45] We'll take videos and all this stuff of I wonder if that helps.

[00:08:48] Does it help to see them working?

[00:08:50] We typically don't ask for or need their actual operations.

[00:08:57] We don't need to see them working in the day-to-day.

[00:09:00] What we need to see is what does their comprehensive list of materials and instruments look like

[00:09:08] for each given procedure.

[00:09:10] When we're guiding teams on giving us that picture that they're taking of each procedure

[00:09:14] we say if Dr. could ask for any material for this procedure, that's what we want to see

[00:09:22] in the photo.

[00:09:23] If you have 20 shades of composite that the doctor could ask for, we want to see that

[00:09:29] in the picture, same with multiple blades or sutures or different sizes of gutter perch.

[00:09:38] Those are things that we want to see because we want to get as much data on the front end

[00:09:42] so that we don't have to backtrack or waste time on the back end sending photos for approval.

[00:09:49] They're like, oh what about the other 12 shades of composite and it's like well we didn't

[00:09:53] get that on the front end now we have to backtrack a little bit.

[00:09:56] Interesting.

[00:09:57] My first question is so which office would be a harder office to do this for?

[00:10:05] Would you rather work in a specialty office or would you rather work in like a general office

[00:10:10] that's doing a lot of different kinds of procedures?

[00:10:13] I got to figure specialty offices have got to be really easy.

[00:10:17] No offense but end of don is kind of do the same thing over and over again.

[00:10:21] Usually one setup is going to do, I don't maybe they do mullers into your teeth or something

[00:10:26] like that but the reality is I feel like the more procedures they have the more complicated

[00:10:30] the setups get end up getting.

[00:10:33] You're kind of right on track.

[00:10:36] So for endo, you're right that's what they do day in and day out.

[00:10:40] They don't have much variety or variations of those procedures.

[00:10:44] They might add in a composite here and there when they are finishing something but they

[00:10:49] do have it more narrowed down with their procedures so we find that can be easier in those specialty

[00:10:55] offices.

[00:10:56] Now that being said because they're specialty, they tend to have every material that go

[00:11:02] with that specialty.

[00:11:05] We encourage doctors not just specialty but other practices as well, general practices

[00:11:11] to really consider what types of materials they're using and not have too many variations

[00:11:17] of each one.

[00:11:18] There's understanding that we need to have a couple of variations for certain scenarios

[00:11:22] but it's not uncommon for us to see four different kinds of looting cement and we're

[00:11:27] like, well why do we have four different kinds of looting cement?

[00:11:30] Oh well, doctors so and so liked this once upon a time.

[00:11:33] That's so real.

[00:11:35] That's so real.

[00:11:36] Yeah, so real.

[00:11:37] So the reality is you're asking about, I mean, Zirk is known for the products, the organizational

[00:11:43] products whether it's tubs or trays or cassettes and all that stuff but the reality is

[00:11:48] you're kind of asking about the whole process and frankly most dental offices probably do

[00:11:53] have a lot of those redundancies.

[00:11:54] And frankly, every time let's just say I did two separate rucanelles today and I ended up

[00:12:02] using a lot of the same instruments but to be perfectly honest there might have been

[00:12:06] at times where I would have closed an access opening with a core material and then I might

[00:12:12] have done it with a composite.

[00:12:13] And frankly no real reason, rhyme or reason for either one of those.

[00:12:16] It might have just depended on my mood.

[00:12:18] And so the reality is you're not only asking like what kind of Zirk products would help

[00:12:23] but the reality you're asking is what kind of simplification can we go through our process

[00:12:28] to make it more efficient and frankly less wasteful?

[00:12:30] That's what I was, I had to Google.

[00:12:32] I Googled, I googled lean processes and lean processes are basically their finding efficiency

[00:12:40] and applying efficiency and reducing waste, whether it's waste of materials or wasted time

[00:12:46] that sort of thing.

[00:12:47] So this is why lean process and lean workflow seems to make sense.

[00:12:51] So it's not just we want to get tubs in your office.

[00:12:55] It's more we want to find, we want to make your processes more efficient, more time efficient

[00:13:00] and less wasteful.

[00:13:01] Is that kind of where you're going?

[00:13:03] Absolutely.

[00:13:04] You know, we understand that practices are focused on patient care and they don't have

[00:13:08] the time and energy and resources to create or find the solutions for lean clinical efficiency

[00:13:14] workflow.

[00:13:15] So we help them understand that it's a benefit that we have our tubs and trays and cassettes

[00:13:21] that we can implement with them, but we really help them understand what the flow and order

[00:13:26] of their practice operations and their materials looks like so that we can help them become

[00:13:32] more efficient, provide more care for patients, help their bottom line as well.

[00:13:38] When we lean up those workflows, it's benefiting the practice in more than one way, more than

[00:13:44] just removing the stress of the day to day having to search for things.

[00:13:48] It's allowing us to have gained more time back so that we can provide more patient care

[00:13:53] and when we can provide more patient care, that's helping the practice out when it comes

[00:13:57] to their revenue.

[00:13:58] Sure.

[00:13:59] Who, when you're dealing with team members, obviously there's office managers, there's

[00:14:03] assistants, there's dentists, there's hygienists, there's lots of who are the people

[00:14:07] that are usually the holdouts or the ones that are dragging their feet.

[00:14:11] I suspect I know, but I'm curious.

[00:14:13] Who are the hardest to do in general?

[00:14:16] I mean, obviously every office is different, but who is the one who probably is going

[00:14:19] to be the hardest?

[00:14:20] I tend to think, I'm going to weigh in that I think it's dentists because a lot of times

[00:14:24] we're sort of the artists and we sort of like the idea that we've got a bunch of different

[00:14:28] materials we can fall back on that sort of thing.

[00:14:30] Right now, if you ask me to simplify some stuff, I know I could, but I don't know that

[00:14:35] I would want to.

[00:14:36] Like, there's a part of me that goes, no, no, no, I want to have this very special

[00:14:39] bird that I use once every month or so, but I want to have it close by, that sort of

[00:14:42] thing.

[00:14:43] Like are the dentists the worst?

[00:14:44] Or is it more assistants who are kind of keyed into the way that they want to get stuff

[00:14:48] done or is it hygiene?

[00:14:49] What do you notice?

[00:14:50] I don't, I'm going to be really honest.

[00:14:53] It's not one specific role.

[00:14:55] It's actually the team members that have been in the industry, you know, for 20 plus

[00:15:01] years and they've been doing the same way over and over and over again.

[00:15:05] You know, they've treated their own idea of what clinical efficiency looks like.

[00:15:09] And it might look organized, it might feel organized to them, but it isn't necessarily

[00:15:15] that way.

[00:15:16] It's not the efficiency that we're looking for.

[00:15:18] So you know, if I guess if I had to pick one specific role, it might be the hygiene team.

[00:15:23] Like I love the hygienists.

[00:15:25] They are amazing part and a core part of the team, but they tend to have a little bit

[00:15:29] of more resistance because it doesn't necessarily affect them as much as it does a dental assistant

[00:15:35] or a dentist.

[00:15:36] They have, they benefit from our process and our system, but they might not feel the symptoms

[00:15:41] like a dental assistant or a dentist does because they're not dealing with all kinds

[00:15:46] of crazy materials.

[00:15:47] They're typically dealing with instruments of some sort basically that's look I didn't

[00:15:51] even think about that.

[00:15:52] It's a good point.

[00:15:53] And the other thing is they're kind of do their own thing.

[00:15:54] They sort of they sort of have their own operator.

[00:15:56] They're already set up.

[00:15:57] They sort of separate from the rest of the office, so maybe they feel like you know,

[00:16:00] you're crowding in on their space.

[00:16:03] Yeah.

[00:16:04] But once we get our system in place with them, they're like why haven't I been doing it

[00:16:07] this way this whole time?

[00:16:08] Sure.

[00:16:09] So they they might have a little bit of resistance on the front end just like any team

[00:16:12] member, but once they get it in place, they're like wow how did I not realize how this

[00:16:16] was going to improve my daily practice.

[00:16:19] So they usually quickly change their mindset.

[00:16:23] Sure.

[00:16:24] Okay, so we've got we've got the photos.

[00:16:26] We've got this set ups.

[00:16:27] We've got we've kind of given you as much information as we can think of to get to

[00:16:31] you.

[00:16:32] And then you guys you guys get this information and I suspect you talk about what

[00:16:36] the goals are for the office.

[00:16:38] What do you do with that information?

[00:16:39] How does that how does that turn into a plan?

[00:16:43] So one of my favorite things to do is what we call tub building.

[00:16:46] Did you ever watch the Instagram videos where they're like putting away their projects

[00:16:50] or like their cabinetry or I'm sorry, they're pantry items like all the cute little packages

[00:16:57] go here and go there and go there.

[00:16:59] It's like this super fun level of organization.

[00:17:02] You're not Instagram kind of guy.

[00:17:04] I tend more towards mountain bikes to be honest, but that's but I get it every Instagram

[00:17:09] has a niche for everyone.

[00:17:10] Right.

[00:17:11] So we do tub building.

[00:17:12] That's probably one of the biggest overwhelming sensation or feelings that the dental practice

[00:17:17] gets.

[00:17:18] I'm going to invest in tubs.

[00:17:20] How do I figure out what inserts go into here?

[00:17:23] Like I don't have the product here with me.

[00:17:25] I don't know if everything is going to fit.

[00:17:27] I don't want to buy something and have to return it or not need it.

[00:17:30] So we do that custom tub configuration for them.

[00:17:33] We have a dental center here in our headquarters in Buffalo, Minnesota where we have a bunch of

[00:17:37] different materials and we do that tub building when we've completed each procedure on their list

[00:17:43] that they've provided us.

[00:17:44] We will take photos and then bring it back to them and review the photos together.

[00:17:50] We want to know did we capture all of the materials that we've talked about that you showed

[00:17:54] me in that photograph if we didn't where did we miss the mark?

[00:17:57] Do we need to reconfigure this tub?

[00:18:00] It's an excellent communication tool because they think, okay, well I see that you put a composite

[00:18:06] tub and a crown of bridge tub, but it looks like there's a lot of overlap.

[00:18:10] Can we combine them?

[00:18:11] So it's a really supportive tool for us to get across a lot of information without having

[00:18:17] to have multiple meetings and phone calls and conversations.

[00:18:20] So I think that that's one of the valuable things that we provide because it doesn't take

[00:18:25] the time and energy and headache of them trying to figure out on their own.

[00:18:29] It's interesting because I'm thinking to myself in my own office, posterior composites

[00:18:35] have a very different setup than anterior composites for me.

[00:18:39] Different instruments, different matrices, not necessarily different materials but I mean

[00:18:42] a lot of it.

[00:18:43] So then the question is, is that worth breaking into different tubs or is it, you know,

[00:18:49] and I suppose every office is going to be a little bit different that way with what works

[00:18:52] best for them depending on how the tubs are laid out and all that stuff?

[00:18:56] Yeah, we find that most practices that have enough overlap with their anterior and posterior

[00:19:01] composites can be combined together.

[00:19:03] Okay.

[00:19:04] In fact, I've only done one practice where we've separated them out and it was a high aesthetic

[00:19:08] practice.

[00:19:09] So they had like several different shapes of composites and lots of extra polishes that

[00:19:13] they used in the anterior.

[00:19:14] So there's one case that we did it that way.

[00:19:17] And the biggest thing is that we're training dental teams to understand where their procedure

[00:19:23] specific materials are stored and nowhere else.

[00:19:26] So if it's in a tub, that's where it goes and that's where it stays.

[00:19:29] If it's in a, the backstock or our make ready area, that's where it stays too.

[00:19:35] So having an understanding of how the system works is going to allow us to have as many

[00:19:40] tubs as you want for as many procedures as you want, as long as I have full understanding

[00:19:45] of how this system and how those materials are supposed to be stored, especially when

[00:19:50] it comes to our procedure specific materials.

[00:19:52] So these are your tubs are meant to be deployed from a central area to the operator.

[00:19:59] So my suspicion is you prefer, I think we laughed about this before, less cabinetry in

[00:20:04] the operator's is better because you don't want to be storing stuff in the operators.

[00:20:07] That's the, the reality is you want to be, because if you store in the operators, then

[00:20:11] you have to restock it to the operators and all of a sudden your restocking is, is all

[00:20:15] over the office and it's harder to keep track of where I think what you just said is basically

[00:20:19] you do your restocking all in one area like it's basically.

[00:20:22] Yeah.

[00:20:23] You kind of put the tubs back together in one area and that's where your supplies.

[00:20:27] Is that right?

[00:20:28] Yeah, central sterilization is like the vital core of our system.

[00:20:33] All of the flow and order comes in and out of there.

[00:20:37] So we dedicate a space in central sterilization for our procedure specific back stock.

[00:20:43] And then we dedicate a place for our tubs and trays and then we dedicate a place for,

[00:20:49] you know, clean side, dirty side, all that good stuff.

[00:20:51] But when we dedicate our make ready station, we have a space where we can grab our tubs

[00:20:57] open that make ready space, restock right from there.

[00:21:00] And then those tubs can go back into the cabinet where they belong and where they stay

[00:21:04] until they're ready to be deployed.

[00:21:06] This makes for really efficient restocking of them versus, and I went through this process

[00:21:12] and dental practices taking your box of all of your materials going from one treatment

[00:21:18] room to the next, to the next, the next.

[00:21:20] It just waits so much time because if I can see that I have it condensed down to one or

[00:21:24] two tubs, I don't need to deploy it in a bunch of different spaces.

[00:21:27] I mean, it makes a lot of sense to do it that way for sure.

[00:21:32] So you have tubs and that's where you're storing materials.

[00:21:38] You also have trays and I'm assuming trays are how you, and you've got cassette what kind

[00:21:43] of run us through some of the different, the different pieces of the system that people

[00:21:47] might be interested to hear about the different and what they're used for.

[00:21:50] Yeah.

[00:21:51] So we have our four key principles.

[00:21:53] We have color instrument management, material management and then storage optimization.

[00:21:57] Our instrument management and our material management is where our Serctinal products

[00:22:01] comes into play.

[00:22:02] Our tubs with our different inserts that we have, that's where we're really going to store

[00:22:09] our procedure specific materials, our active stock of those materials.

[00:22:13] When it comes to our instrument management principle, our trays with locking covers go

[00:22:19] along with our cassettes and our burr guards, our endo guards, our burr blocks.

[00:22:24] So anything instrument related is going to live with that tray and locking cover.

[00:22:28] The locking cover gives us compliance when it comes to transporting dirty and contaminated

[00:22:33] instruments back to central serialization, so everything is contained in there really

[00:22:37] safely being moved throughout the practice.

[00:22:40] Our burr guards and our burr blocks fit right on those trays with our cassettes as well.

[00:22:46] So they're not going to have to be big separately or anything like that.

[00:22:50] It's all encompassing and all of our colors go in every single product that we have.

[00:22:55] So if you're looking for endo guards in a certain color, you know that you're going to

[00:22:59] find a tray of the same color, a cassette of the same color and a procedure top of the

[00:23:03] same color as well.

[00:23:05] The colors are interesting because then the simplification, there's four people that

[00:23:10] have worked there forever, they know that red is surgery and blue is endo and all this

[00:23:16] stuff.

[00:23:17] So not work there for a long time can learn the colors and they don't need as much,

[00:23:22] you know, they don't have to work too hard at it because the colors are always the same

[00:23:25] every time.

[00:23:26] That's the idea that procedures are, you know, your procedures, you have a procedure

[00:23:31] tub that has the materials for that, you have a tray and cassettes that have those instruments

[00:23:37] and they all in the burrs.

[00:23:38] I just put that together right now actually.

[00:23:40] So all those things, you just get the same color and get it in the room and you're going

[00:23:44] to have the right stuff.

[00:23:45] That's really interesting.

[00:23:46] I didn't think about that.

[00:23:47] So it's not just the materials, it's also the instruments and they're all in the same

[00:23:50] color.

[00:23:51] So just remember that color.

[00:23:52] I do like that.

[00:23:53] I just put that together right now.

[00:23:54] Yeah, good.

[00:23:55] Light bulb moment.

[00:23:56] And we set the teams up for success when it comes to understanding those colors and

[00:24:01] the corresponding procedures with it.

[00:24:02] We've created a procedure chart.

[00:24:04] So it is a color coded chart that they store in central sterilization right next to their

[00:24:09] tub and tray storage so that even if a front desk team member has to come in and put the

[00:24:15] clinic out there, they can look at that and say, you know, you as a doctor can say,

[00:24:20] hey, Jayne, can you please get me the red tub?

[00:24:23] They're going to walk in there and see that the red tub is for oral surgery and they can

[00:24:26] grab the red tub, the red tray, bring it to the treatment room.

[00:24:29] So we've already identified how we can use that color coding chart to help support this

[00:24:34] system and make it even more flawless.

[00:24:38] That's cool.

[00:24:39] So as far as people having a hard time implementing, let's say it was a little bit more

[00:24:45] state.

[00:24:46] Let's say you've done the, you've done the put the tubs together.

[00:24:49] You've put their procedures together.

[00:24:50] You've trained them.

[00:24:52] They have this four week period between, you know, when you've trained them and when

[00:24:56] you go back over it and see where the, the troubles or the successes are like what are

[00:25:02] the things that you run into the most that they struggle with?

[00:25:07] You know, and like what are the things that that maybe I wouldn't think of that you

[00:25:13] see often because you do this all the time?

[00:25:15] Like what are the things that they struggle with when implementing the new system?

[00:25:18] One of the biggest things that we see that they fall back to is they start restoring materials

[00:25:27] back to where they had it before.

[00:25:29] So if there's a drawer where they used to have their procedure specific materials or like

[00:25:34] glove overstock, they're going to start bringing it back into the treatment room.

[00:25:38] So that's probably the first place where we see the, see the system start to break down

[00:25:43] is they go from, you know, centralized locations of story in their materials, which is what

[00:25:48] we've set up to bringing those back out of that central space and into too many places.

[00:25:54] So that's quickly, that's usually the first thing that's going to break down when it happens.

[00:25:59] The second thing that we see is our trauma or our trays with locking covers.

[00:26:04] We create one for each cassette.

[00:26:05] So if we have five setups, there's going to be trays and covers for each one.

[00:26:09] They might start to just break it down and just use like one or two trays and not each

[00:26:14] one.

[00:26:15] It defeats the purpose of the grab and go efficiency that we've created.

[00:26:20] So now they have to grab a tub and a cassette and now a separate tray with a cover.

[00:26:24] So that might be another place where we see the system start to break down.

[00:26:28] It's funny too, because I'm wondering to then that like, okay, here's the question.

[00:26:34] So you're setting someone up with a new system.

[00:26:37] Do you find that they typically don't have enough capacity for sterilization and cleaning

[00:26:44] instruments?

[00:26:45] Or do you find that they usually do, it's okay and you just have to adapt them to it?

[00:26:48] Because typically when you, a lot of these places probably have not had cassettes before

[00:26:52] and cassettes are a little bit different and new.

[00:26:54] And there's huge advantages to it but for people who haven't used them, it's probably

[00:26:57] very awkward and different.

[00:27:02] You know, we find that they usually have enough capacity.

[00:27:04] We definitely recommend when you transition from pouched instruments to cassettes that

[00:27:08] you're probably going to need a second autoclave.

[00:27:11] Sure.

[00:27:12] And most practices don't have a resistance to that.

[00:27:15] If they do, they just have to understand that it's going to take them longer to process

[00:27:18] their instruments in their normal workflow.

[00:27:22] So they'll quickly grow to two autoclaves where we see the biggest challenge within like

[00:27:29] their sterilization process is not enough clean storage after the autoclave.

[00:27:35] So when they transition to cassettes and a tub and tray system in their current central

[00:27:40] sterilization, they might not have enough space allocated on the clean side and we're very

[00:27:45] intentional about what can be stored on either side of the autoclave because of cross contamination.

[00:27:51] So we do find that there are times where you might only have one column of clean storage

[00:27:58] but you have a robust side on the dirty and that's a major imbalance that we're seeing

[00:28:02] among practice designs.

[00:28:04] And that's something a shift that we're trying to make within the industry so that we can

[00:28:07] set teams up for success.

[00:28:09] Whether they go into tubs and trays or not, there needs to be additional storage for

[00:28:13] procedure specific materials on that clean side.

[00:28:16] So we need to see the shifts start to change where we're giving them additional storage

[00:28:20] on the clean side and you know not shrinking the dirty side but just being intentional on

[00:28:26] what is there and what can be stored there and we don't need any extra room over there.

[00:28:30] That makes sense.

[00:28:31] It's interesting too, I wonder do you find that people once you've set this system up

[00:28:38] to do people typically have enough instrumentation?

[00:28:42] Like my thing is like I always wonder I don't have a huge office so but an office that might

[00:28:46] have multiple operatories or multiple dentists you know doing procedures the same procedures

[00:28:52] and different operatories and that sort of thing.

[00:28:55] So how do you know what the right amount of instrumentation because the wrong amount

[00:28:59] is wasteful, like too much is wasteful not enough is tragic and it's a car wreck in

[00:29:04] the back office when you're like oh my god, you know the one endo hand piece isn't sterilized

[00:29:09] or some stupid thing like that.

[00:29:10] So how do you find offices?

[00:29:12] I mean is it better for them to just have more for just in case or does that go against

[00:29:18] lean principles?

[00:29:19] I'm curious.

[00:29:21] Yeah, it definitely plays into those lean principles.

[00:29:23] We want teams to be as lean as they can and it does come into their instrumentation for

[00:29:27] a couple of reasons.

[00:29:29] If you have extra you're going to have to store it someplace and it just takes up space.

[00:29:34] And secondly it creates confusion.

[00:29:36] If all of us said I have a drawer full of instruments and I have a new team member come in

[00:29:40] they're like well what do I need to do with this stuff down here?

[00:29:42] Where do these things get put after sterilization process happens?

[00:29:45] So we definitely want to have a balance of instruments that are actively in cassettes

[00:29:53] being used and then a small supply of like extra instruments.

[00:29:57] You know, we always want to have extra mirrors and explorers and cotton players but do

[00:30:01] we really need 18 extra ball burners?

[00:30:05] No, maybe we need one or two on hand so if something breaks we have one to replace it

[00:30:09] right away and not have to store additional instruments.

[00:30:13] So we really try to keep that as tight as possible as well.

[00:30:17] I don't know if we find people having to order like when we implement our system usually

[00:30:22] they have enough instruments to reallocate across the system.

[00:30:28] We don't, you know if a practice comes in and says I do six crowns in a day and that's

[00:30:34] part of our intake information that we gather.

[00:30:36] We ask them to give us an average of how many procedures or how many times per day are

[00:30:40] you doing this procedure?

[00:30:41] And if they come in and say I'm doing this procedure six times a day, we balance it out

[00:30:47] and go okay well you're probably doing three in the morning, three in the afternoon.

[00:30:51] You're going to need three instrument setups and we have that hour during lunch where

[00:30:55] we can be reprocessing those instruments not to mention the reprocessing through the

[00:30:59] day.

[00:31:00] So we don't want to oversell them with our product and that allows us to balance out what

[00:31:06] they already have into the appropriate amounts of cassettes for each procedure.

[00:31:12] My suspicion is most offices probably have more instruments than they need for these

[00:31:18] sorts of things because there's a certain paranoia if you don't want to get stuck without

[00:31:23] you know, the classic thing is I think I probably have more hand pieces than I need but

[00:31:27] I've the few times I've gotten stuck with not enough has been a huge tragedy in my brain

[00:31:32] so I think we probably tend to go and I suspect there's a lot of offices like that or it

[00:31:36] could you know, go the complete other way like if you're doing a bunch of hygiene you

[00:31:38] don't have enough inserts for your ultrasonic.

[00:31:41] I guess it could go either way but so the trick is to try and find the best balance and

[00:31:45] then if you find that balance is off figuring out where what you need to do differently after

[00:31:49] the fact like okay when you maybe we need to add another setup for this or something like

[00:31:54] that but probably working with the system for a while will give you that information.

[00:32:00] Yeah and we you know, we've done this for so many dental practices and part of that

[00:32:05] four-week follow up is asking that like did you have enough instruments to get you through the day?

[00:32:10] Did you find it? You were falling back or falling behind because you didn't have them.

[00:32:13] So that's part of that follow up information is to make any corrections to our system

[00:32:18] because we want to always be learning from them so oftentimes we find that there was a good balance

[00:32:24] and if it if we didn't it's usually because we didn't get the correct information on

[00:32:30] the front end. Maybe they misunderstood how many times per day or maybe they had an influx of

[00:32:35] procedures that they suddenly started to do so it uh oh and the beauty of our system is

[00:32:40] it allows for growth really easily so we can quickly deploy additional you know, cassettes

[00:32:47] and trays and burgards to the practice um if they need it so it's not uh it's not something

[00:32:53] that we find as a big barrier of not having what they need when it comes to instrumentation.

[00:32:59] Okay so um you've got your instruments you've sterilized them and all this sort of thing you're

[00:33:05] you're working with the system how often would you recommend someone on the system like

[00:33:10] reevaluate to see if they can type because because one of the things they talk about mean workflow

[00:33:13] sorry lean workflow is that that it uh you keep reevaluating like it's sort of constantly checking

[00:33:19] for for new places so do you check in with offices that have been using the system for a while and see

[00:33:23] you know it's like to reevaluate absolutely we want to make sure that our teams are being successful

[00:33:30] with the system and like I said before we want to be learning from them um whether it's good,

[00:33:34] bad or ugly so we want to know how their feedback is going so we do check in with them periodically

[00:33:40] we always say that you know if we might be in your neighborhood some days so just make sure that

[00:33:44] you haven't so work in that we send it up and we have gone back to practices and done those follow

[00:33:49] ups if we're available to do that um and we always leave the line of communication open we want to

[00:33:54] make sure that they understand that we're a resource for them going forward uh especially in the

[00:33:59] practices that are you know in transition in their timeline maybe they're looking for a system

[00:34:05] that's going to improve their practices uh become more lean more efficient um and then they're

[00:34:10] looking for growth so we want to help set them up for success at their current situation and then

[00:34:15] support them as their growth plan occurs so if we uh are going to be moving into a new space or

[00:34:22] during a remodel we want them to understand that we are here to help them make those decisions

[00:34:27] and help create the right workflow of their design and of their treatment room or their central

[00:34:34] sterilization cabinetry so we don't we don't go away once we're finished implementing this system

[00:34:39] we do follow ups and we really make sure that they understand that we're here to uh to continue supporting

[00:34:45] you uh with whatever um whatever needs they might have so it i will say this the situation

[00:34:52] we've talked about here a little bit is almost like an office that wants to increase

[00:34:56] sees they may have a problem or some hang ups and wants to improve but there's also a different kind

[00:35:00] of practice which is a brand new practice that's saying okay so we we have no clinical systems or

[00:35:06] i mean in this new building we don't have a physical workflow or whatever so that has to be the

[00:35:11] most fun because then if you get in on the ground floor you can like build it right into the

[00:35:15] into the workflow so tell me a little bit about that oh yeah that's our favorite way to to start

[00:35:21] and i think the most critical piece of this scenario is getting Zerks consulting team involved

[00:35:28] before floor plans are created and solidified before um cabinetry is decided on we really

[00:35:35] want to be on the design phase before things are set in stone because we so often see um where a

[00:35:43] practice is you know a month from opening its doors and we need to implement this system and they

[00:35:49] have too much cabinet they already have a ton of cabinets the patterns and told them I know it's

[00:35:53] kind of where it works right yeah yeah so so they they we want to help them create a very

[00:36:01] efficient workflow whether they go with zerk dental products or not we want to be you know it's

[00:36:07] our responsibility as industry partners to set them up for success when it comes to their lean

[00:36:14] clinical workflow so we definitely want to be in on the front end of that now you set it like

[00:36:20] this brand new office it's a clean slate for us so we get to go in and a lot of the barriers that

[00:36:26] we have on our existing practices is like the clean out before we can move in it yeah yeah

[00:36:32] where these new practices they're already cleaned out so it's really fresh for us to go in and we

[00:36:36] create our plan a gram we help the team understand what the day is going to look like and then go

[00:36:42] in and implement those tend to go a little bit more smoothly because we do have that clean slate we

[00:36:47] can get in a little bit early we get a lot of the photographs and design plans where we can do a lot

[00:36:53] of the pre-planning and have you know it's like having a playbook when you're going to to the football

[00:36:57] game so it's really a good setup for us to implement in yeah no I mean we've really covered it I feel

[00:37:04] like I feel like we maybe dug in a little deeper this time to talk about it now but I suspect there

[00:37:09] are still be questions so I'm gonna make sure that we've got some zerk people in the Facebook

[00:37:12] group for people who might have questions about this stuff and and I mean there's it's funny because

[00:37:19] part of the idea of going into this sort of new organization and workflow is that I'm gonna have

[00:37:26] to change I'm gonna have to make some changes and that's hard that's hard for honestly

[00:37:31] mid-practice mid-career Dennis like me thinking to myself yeah I just want to go home you know

[00:37:36] I just want to I don't but but the reality is there's a lot of value to be had here

[00:37:41] like and that can make your life easier it can make a lot you know it can make it so you can see

[00:37:44] more patients or get out earlier or something like that there's there's some value here that

[00:37:48] and they're yeah there is changes a little bit of a learning curve there's this is probably not

[00:37:53] anything like a lot of the learning curves we have to go through as Dennis and dental teams but

[00:37:57] but it is you sort of have to commit to the idea that this is at the end it's going to be a much

[00:38:02] better situation so you almost need a little pep talk with your team to make sure that they understand

[00:38:06] this is there's a reason we're doing this we're not just doing this to to complicate your life

[00:38:10] like there's there's at the end of it you're going to be really glad you did it I think that and

[00:38:14] I guess do most your clients give you that feedback that yeah once we got through the the hump

[00:38:19] it was a it was a really good thing to have done absolutely yes and you you nailed it we there's

[00:38:25] a lot of pep talks that we have it's pep talks with the doctors pep talks with the team with the assistance

[00:38:30] of front desk like everybody that's where that comprehensive training comes into place because

[00:38:35] we want the system to stay intact we want everybody to understand we start every reset with that

[00:38:42] pep talk you know we acknowledge the time and energy and work that they've put into their career

[00:38:47] and we're not invalidating that we're encouraging that and what we're really trying to do is just

[00:38:52] improve the systems that they've already put in place so that they can perform their best

[00:38:56] dentistry so there's a lot of those pep talks that happen a lot of the encouraging information

[00:39:02] because it can feel it can feel invasive and people feel vulnerable when we come in and

[00:39:07] and just make a big change for them so we you know having walked in those shoes as a clinical

[00:39:13] dental assistant years ago I can relate to that and as the rest of us consultants can too we don't

[00:39:20] ever want anybody to feel like we're coming in and changing things because they're wrong

[00:39:24] we're coming in and changing things because the system that they've put in place isn't working

[00:39:28] for them anymore and there's room for improvement that's and that's that's the way you have to look

[00:39:33] at it for sure all right listen if you have any questions or comments for Kate or any of the

[00:39:37] other dessert folks we'll make sure they're in the Facebook group bra'll make sure that they get

[00:39:40] the the questions because of course they want to they want to work with you and uh well make sure

[00:39:44] that all the stuff is in the show notes and we'll definitely talk about on the Facebook group Kate

[00:39:49] thank you very much again for coming on I really appreciate it yeah thanks again it was a pleasure

[00:39:54] chatting with you again I look forward to many more