EP 104: Alleviating Bottlenecks and Designing Efficient Dental Offices with Angie Bachman

Today on the Double Your Production Podcast, Dr. John Meis and Wendy Briggs are sitting down with Angie Bachman of Design Ergonomics to about how she helps practices become some of the top-producing offices in the nation.

Design Ergonomics has revolutionized dentistry by applying lean manufacturing principles of the famed Toyota production process to optimize offices. They improve everything from patient flow to team flow, allowing the overall environment of the office to improve. Their methods reduce wasted time, energy, and materials so practices can be extremely efficient and productive while providing a better patient experience.

In this episode, you’ll learn:

  • Why simply moving faster doesn’t improve efficiency in a dental office
  • How to identify wasted time or energy in a practice’s operations
  • How to create a centralized, low-cost inventory system
  • The best place to start when optimizing your office and simple things you can do to improve your efficiency
  • Why there’s a tendency to overcomplicate an operatory and how to encourage the team to maintain simplicity
  • How to create a universal, agreed-upon setup and processes that are the same in each room

We hope you enjoy today’s episode!

If you’d like to get in touch with Angie Bachman, you can reach her at abachman@desergo.com or www.desergo.com 

Watch the episode:

Or, listen to the episode below:

Speaker 1:
Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you are going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.
John Meis:
Hey everybody. Welcome to this edition of the Double Your Production podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey, Wendy.
Wendy Briggs:
Hello, Dr. John.
John Meis:
And we are so excited to have a guest with us. Angie Bachman is here, and she is the Director of Clinical Training and Education at Design Ergonomics. Design Ergonomics is a fantastic company. Angie, why don't you tell us a little bit about the company and about what you do?
Angie Bachman:
Well, first of all, thank you Dr. Meis and Wendy for having me today. I love talking about this stuff. I am the Director of Clinical Education and Training at Design Ergonomics. I have been with the company, I think I would say, since 2011. We are a dental office design firm, and we like to say we design, equip, and train the nation's top-producing dental practices. And I'd have to say, based on my experience, that is true. I sold designs for Dr. Ahearn. Dr. David Ahearn is my boss, our founder, and practicing dentist, ish. He's kind of gotten away from that a little bit, and spending a little more time with us in our factory.
And you know, maybe your clients don't, or those who are listening to this podcast don't, but we do manufacture dental equipment in Fall River, Massachusetts. We are a direct distributor of this equipment, so you don't buy our stuff from anybody else but us, and we like that.
And the training program came, I would say, based on... we would have offices buy our equipment, designs, or they would read Dr. Ahearn's book, The Guide to Maximizing Productivity, and go, "Man, this is so great. I'm going to put it in my office, but I have no idea where to start and how to get this thing rolling." We thought that was an opportunity to start a training program.
And Erica St. Pierre, who was the director of the program, she developed a fantastic, strong program. And really, what it is, is it's a way to improve the way you work by utilizing some lean manufacturing principles, which we talk about. It's not like you need to have your Six Sigma to do this, but it is, generally speaking, a way to improve the way you work, and never compromising care, optimizing that the patient is your customer, it's your client, so we need to make sure that you're adding value at every turn. And we help create that in the office, and improve patient flow, worker flow, overall morale, quite frankly. It is what I was put on this planet to do, I feel like, just based on my personality. Go in, get it done, and follow up later. But it is a game changer, that's for sure.
John Meis:
So Dr. Ahearn and I have been friends for 20 years, at least, and we've been students, studying in different ways, in different parts of dentistry, but what he has really mastered is he's applied the principles of lean and the Toyota production process to dentistry. And that process reduces waste of time, of materials, of movement, so that things run more efficiently. They run also more predictably, and they also run less expensively.
The nice thing is that, as he was learning these things, he was applying them in his own office, and his office was kind of a lab. Last time I was there, there was all different kind of ops setups as he was testing things out. There was at least one op that always looked different than the rest because they were testing [inaudible 00:04:53] Yeah, exactly right. And so he mastered this, and now part of your job is not only teaching this to other people, but you actually go into offices, don't you?
Angie Bachman:
I do. That's my favorite part. I have a team of five now, and so there are five people in the world that do this training, I like to say, and we are the only five in the world that do it specific to dentistry. It is a process, I'll be honest. It takes a couple of months to actually get us to the practice. There's a tremendous amount of pre-work that's involved. We want to see how you practice without ever setting foot in your practice, studying some questions to some answers. What technology do you have? How many chairs? How many assistants? Hygienists? What are your goals? What are your bottlenecks? And we can do that, listen to those answers, and then take a series of pictures and imagine how the day would run. Our team is made up of five clinicians, of course. We already know how the clinical department runs.
John Meis:
Back in the day, Design Ergonomics designed an expansion on my office, and so you guys had me videotape myself working, and then take pictures of the whole office. Now, you've got it down that you've seen so many of them, it's just one after another, you just get pictures and you can tell where there's flows, and there's bottlenecks, and where there's not enough space, and where the organization's off, can't you?
Angie Bachman:
We can. And we're always thinking in our minds, what's going to make those improvements is universal principles, like keeping things simple. We want to have a visual resupply. We want to be able to see what you're working with and know how much inventory you have. We like the modular capability of it. So you no longer bring inventory to your operatory, you actually bring your operatory to inventory to restock. And that's just a different concept. "Well, what do we do with our drawers, Angie?" I go, "Nothing. Put a plant on it, or you can get it out of here. I don't..."
John Meis:
Tear them out. Yeah.
Angie Bachman:
"We'll never use it. It's too far away." You think about how many times you open a drawer and look, and then go, "Oh, it's not in there." Close the drawer. Time, right? The get up and go get times are just all considered waste. [inaudible 00:07:52] Sorry, go ahead.
John Meis:
Go ahead, Wendy.
Wendy Briggs:
No, I was going to say, we often teach that dentistry is a business of flow, and people often get stuck there. They think that means we've got to shorten appointment times or there's other ways to influence it. Very rarely do they take a step back and try and evaluate where can we improve the flow with what we already have? And that's where we see magic happen.
We also teach that effectiveness is doing the right things, and efficiency is doing things right. So when you combine both of those, you have much higher productivity. And so I viewed it as you have become our partner within TTI that can help people sort out if they're doing things right or if there's opportunity for a higher level of efficiency. And like you said, when you're working in that every day, you often experience a sense of overwhelm, and you don't know where to start, and you don't even know how to measure how effective you are with your time based on what's good, what's bad. We don't know. And that's so amazing about your team and your process and your program is that you can help evaluate that.
And you're an independent third party. Your goal is to help everybody get better. Anybody who wants to get better, that's your goal. And you've created not only the systems and the training to do that, but the products too, which is what I love about Dr. Ahearn's scientific mind. I love how he thinks, because there's not a solution available. He learned early on there's some things that just weren't readily available to dentists, so we're going to make them. And that's essentially what's evolved in what he's built.
Angie Bachman:
I'm so glad you said that because that's the truth. And when I saw him speak for the first time, it was years ago, like 2006, and I'd been a clinician for a number of years, and then a consultant, and then I'm watching him speak and I'm like, "What? What is that?" I mean, I could have done that before. What? And I'm like, "I got to be a part of that one day."
Sometimes you just don't know what you don't know. And bringing this simplicity to a dental... We just take all the complicated out, all those things that bottle the practice down. And like I say, if I could save you 5 to 10 minutes per appointment, that's per appointment, not per column, not per doctor, that is per patient, per appointment, that would allow you to open up an opportunity for your community, who deserves care from your fantastic dental practice. Everybody deserves that. And let's open up ways to allow that to happen.
John Meis:
And everybody thinks becoming more productive... The natural thing that a dentist thinks is, "I have to work faster. I have to drill faster. I have to do things faster." But that's not really where the advantage comes from. Dr. Ahearn taught me that the drill on tooth time, from the most productive dentist to the least productive dentist, isn't that much different. It's everything else that...
Angie Bachman:
It's everything else. It's that mundane... all those things that you don't consider as part of flow, as doctors, so forgive me, or as providers, sometimes all that work... I'm an assistant, and so all that... I still have to maintain your handpiece. I still have to maintain your autoclave. I still have to find time to clean traps and shock water lines and things like that. I still have to find time to do that within this timeframe. And we have a full patient load. But if I can make all of those other processes simpler... And I use simple more than anything else because the simpler it is, the more efficient it runs, because there's nothing complicating it. I can give examples [inaudible 00:12:00] John Meis:
[inaudible 00:12:00] goes up a lot. The simpler it is, the more consistent it is.
Angie Bachman:
That's right. And so we just make things simple. If I have five doctors that have five different bonding agents, we have to figure that out. That is hard to coach. In this day and age, with staff changes or team changes and your human capital changes, I don't want it to be difficult to coach someone up into their role. It should be simple, that anybody could do it.
John Meis:
So when I started applying these principles in my office, there were a handful of things, but everything was simplification. Everything was, in many ways, centralization, having everything in the same place, making it visual. So my inventory of stuff that I had to have went way down, as most people's does, I'm sure. When we emptied the drawers that we had in the ops, there was thousands of dollars of outdated materials. And everybody thinks, "Okay, well, we ran out of this one time, so I'm going to squirrel a little away and summon away in my op just in case we run into a rainy day." And then it expires, and you end up throwing out all this stuff. So when you come into an office, what are the main places where you're focusing on as you re-setup the flow and the process?
Angie Bachman:
Good question. Sterilization is one. That is happening after every patient, and I want to make it... Our goals as clinicians is to... Our instruments have to be clean before they go in the autoclave. How you achieve clean is entirely up to you. I'm going to give you the most efficient way to do that, to get your instruments clean. Not sterilized, because autoclave's the only thing that will do that. But to get them clean should not be using an ultrasonic, it shouldn't be hand scrubbing instruments. It should have a nice, streamlined flow that doesn't require much thought that anybody could do. It should be the first thing that you can teach, the first thing that can be duplicated, replicated. That process can be done simple. Cassettes are a must, one universal bur block, one universal hygiene cassette. And Wendy, I would love your opinion on what your thoughts are on that, if I can ask a question because [inaudible 00:14:58] John Meis:
Yeah, absolutely. Wendy, do you want to talk?
Wendy Briggs:
Yeah. We're aligned in that, Angie. Dr. John and I always have to tread carefully. We have to gain the trust of the practices we work with first before we start having radical ideas like, "You really shouldn't have that many scalers in your setup." So for me, a basic prophy setup is fairly simple. It's five things, a mirror, a perio explorer, a probe, a sickle, and a universal. That's your basic prophy setup. And if you need more than that, chances are you're probably not doing a prophy or you're not using your power scaler enough, because that is a universal tip and you're supposed to be able to scale every surface of every tooth with that.
Of course, there's differences when we get into periodontal scaling and periodontal services, but even then, I always teach that you grab your basic setup plus a setup that has three curettes, three or four. My favorites are a Gracey 1/2. There should be Graceys for each, 11, 12, 13, 14, and a 1/2. You can have minis or regulars, depending on what you want. But really, we make things way too complicated, and that's something that we call a very common time vampire in many practices because hygienists are very meticulous people, and so if we have a setup that has 12 to 15 instruments, we want to use all of them every time, and that causes us to run behind.
So certainly, I'm not saying that there can't be a drawer of specialty instruments when you come into a unique circumstance, but for the most part, we should all simplify in that area as well. That's my opinion on that.
Angie Bachman:
Well, thank you for sharing that because I know it's your podcast, but I'm like, "You know what? Maybe I'll take this opportunity to get this expert's point of view as a hygienist." So thank you.
John Meis:
So Angie, when we put this into place, and we got the team together, and we laid out the concept, "Here's the cassettes. We only had this many spots. Let's decide. It's only going to be one way. Everybody's got to do it the same way," there was a lot of groaning. There was a lot of yelling. There was a lot of tears. And that was mainly the doctors. Everybody else seemed to capture the idea and go with it. But boy, I'll tell you, it made it so much easier because we had four doctors in our practice at the time, and with the way we had it, it was so complicated that assistants could only work with this doctor because they knew what that doctor wanted. Highly inefficient, big blockage to same-day dentistry. And when we got this down, and it wasn't easy, but when we got it down, it really improved us and allowed us to get team members in and trained really quickly because we'd simplified it so much.
Wendy Briggs:
And I would say too, to your question about the hygiene instruments, hygienists can become nested and only want to work out of their room because that's where their instruments are. And that impacts patient flow and patient service and patient care. And so when we are able to have a universal setup that everybody agrees upon and is willing to use, it minimizes the complication there.
And as you mentioned, when we're talking about adding in same-day services on the hygiene side, preventive services, it's not extra hours of time we need, it's a handful of minutes. So those minutes become critical in really driving a higher level of care for patients, which reflects in the productivity at the end of the day.
Angie Bachman:
Absolutely. And communication is key. It is true. I run into that a lot. "Oh, that's my room." And I correct them throughout the two-day process, but it's not like we're introducing it for the first time when I show up. I want you to take a look at the guide. I want to have conversations with your clinical leads. I want to really involve them because Lean, a Lean culture, teaches us to really involve the people who actually do a lot of this work. And what do you think is working great in your practice? What do you think isn't? They have a pretty good idea what I want to do when I go in.
If I just say, "Hey, get on your radio or type a note," or whatever, YAPI system or whatever they're using for interoffice communication that, "Hey, my conversation with a patient is, 'Do you have another 10 minutes? You've got a small filling the doctor just diagnosed. Let's get it done right now.'" Who does benefit? It benefits everybody, especially the patient who doesn't have to schedule and take another day off of work or whatever the case may be. And it saves on infection control, time, all of the things that could be bottlenecks in patient care and flow.
John Meis:
The experiences of our clients, and you've worked with many of our clients, the experiences that they've had have been fantastic. Everybody says that when you come in, that it's a whirlwind, it's a tough couple of days getting it all done, and everybody letting go of some of their preconceived thoughts about how things are. And change is always difficult. Change is difficult, but progress is easy. And so once it's done, then everybody just loves it because again, it's so much simpler.
What we see is that their productivity rises because there's less wasted time, effort, movement. We also see that there is a reduction in supply costs, and in offices of ours that you've worked with, we're seeing somewhere around a 10% to 12% drop in supply costs. Largely, that's because there's elimination of waste.
Also, there is less wear and tear on the team because they're not having to deal with complexity. We know practices that have an extra assistant that's not really providing value to patients, they're dealing with the complexity. And so in some offices, they're able to deploy that person in a way that can provide more value for patients.
Angie Bachman:
Right. Sterile [inaudible 00:21:35] Wendy Briggs:
Another thing too, Angie, I would add to that, for years, Dr. John and I, one of the things that we do with practices is we help them with their mindset shift, opening up the door and helping them see the value in same-day dentistry, and seeing the value from a strategic standpoint. Then they often need help on the tactical, and that's where sometimes we hand the baton to you, because they're out of capacity, they don't know of a way to overcome that beyond a second location, which sometimes they eventually do. But I've seen you guys work miracles with taking an existing facility, and all of a sudden, you've got two more operatories that are there with some creative reconfiguring.
Other things, like you mentioned, is helping the team know where to start with the tactical side of doing same day. I think that's what it's been so rewarding for me to watch, on the outside looking in, is we've got some of the strategic concepts nailed, but then you guys can step in and bridge some of the gaps on the tactical, how to actually get it done day-to-day in the [inaudible 00:22:39] Angie Bachman:
Yeah. Wow. I love this conversation. It's really great to hear. I hear a lot from the clients that I've worked with that have worked with you, and I would consider them friends at this point. And if they need anything, I'm Johnny on the spot for them. Even if I might be in the middle of something, I will break free because they get it. They get it.
But it is a whirlwind, like you said, to go back on what you were saying earlier. It is going to be a colossal mess before we actually put the pieces together. The five S's, sort, set, shine, standardize, and sustain, we spend a heck of a lot of times sorting. Do you use it? Don't you use it? And if you don't use it, what do we do with it? Do we donate it? And I ask those questions a lot. And then what we do use, it's how often do you use it?
They're fun, and they're interactive. I try to make it fun. Sometimes we'll get obnoxious, and I'll have a hygienist who can't live without 15 flavors of prophy paste, and I'm just like, "Whoa. Okay. How could we shrink that down a little bit? Actually, a lot." But we have fun with it. Sometimes they'll look back and go, "Man, that was really absurd. Why did I do that? How much time I took in buying the product and then asking the patient, 'What flavor do you want?'" Ten minutes goes by, and you finally have your prophy paste flavor. It's like, what? It's just some of those things that we can simplify down and make it easy.
John Meis:
Yeah. So if anybody listening wants to have their office run more efficiently, wants to increase productivity, wants to simplify everything, eliminate complexity, or at least dramatically reduce complexity, and be able to provide more care for patients, then this process is really, really helpful.
Angie, if somebody is considering working with you guys and making these improvements, what would be the first step for them?
Angie Bachman:
I would schedule a call with them. I do that because every practice is different. Even though the principles are pretty standard, every practice is different, and I want to learn about it. We don't just say, "Okay, hey, sign up here, and let's just get to work." I want to know that you're not going to throw me to a pack of wolves. I've shown up at a couple of offices, and they're like, "Hey, have at it." Okay. And they're like, "Who is this?" I want to really get an understanding with a doctor. "What are your goals? What is the plan?" If they feel like they are at capacity, I want to maximize that space. How can we increase some capacity to help you earn that X or be more productive, and then go ahead and be able to start that second location, or build that expansion, or do some charity work, or whatever their goal is. I just want to know what those things are because that's a really good place to start. And then we'll go from there and get a basis on how we're going to treat reboot training.
John Meis:
Yeah, I love that place as a start because you understand the vision, and you get to know maybe what some of the obstacles might be so that you can prepare for it. The principles are the same, but it's not cookie cutter. You adjust it depending on what the doctor wants, what their vision is, and what the obstacles that they're facing are. I love that.
If somebody were to give you a call or set up a call, how would they go about that?
Angie Bachman:
I would just suggest that they would email me. The likelihood of me being able to respond to that is much better than me picking up a phone. If any of your clients ever have worked with me or will work with me, will soon learn that I am in it to win it, and my focus is 100% on that practice, and I don't let anything distract me from that. It could be a couple days, so email is always best. I'll always check that. You'll hear from me within 24 hours. And my email address, do you want me to share that?
John Meis:
Absolutely. We'll put it in the notes, but go ahead and share it.
Angie Bachman:
Oh, okay, perfect. It is abachman@desergo.com. Our company website is www. -D-E-S-E-R-G-O .com. And my name is Angie Bachman, and my email abachman, B-A-C-H-M-A-N @desergo.com.
John Meis:
Our clients that have worked with you call you one of two things, Honey Badger or Ergo Angie.
Angie Bachman:
That's so fun. Oh gosh. You know what? I'm going to get a t-shirt made.
John Meis:
There you go.
Angie Bachman:
At your next event, if I have the opportunity to join that, to join you guys at that event, I will wear that shirt or wear that hat. I'll be flaunting it.
John Meis:
Awesome.
Wendy Briggs:
Yeah, love that.
John Meis:
Wendy, any last thoughts?
Wendy Briggs:
No. Thanks so much for joining us today. Like I said, we love to always have content nuggets that our listeners can use right away, and I think they've gotten a lot to think about here today from you, Angie, so we certainly appreciate that.
Angie Bachman:
Well, good. And I can't thank y'all enough for inviting me to talk with y'all.
John Meis:
We're super glad to have you, Angie. All right, that's it for this episode of the Double Your Production podcast. We'll see you next time. Thanks, everybody.

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