In this edition of 5 Questions we meet Dr. Sami Bahri, sometimes called "The Lean Dentist," and author of the recently-published Follow the Learner: The Role of a Leader in Creating a Lean Culture.
1. Who are you, what organization are you with, and what are your
current Lean-oriented activities?
I am a full time practicing dentist in Jacksonville
Florida, since 1990, and co-founder of the Bahri Dental Group, where we
practice Lean Dentistry, to the great benefit of our patients and our practice.
I was born in Lebanon where I received my dental
degree from the Saint Joseph Jesuit University. I spent three years in Paris,
France, specializing in dental prosthetics, and upon my return to Lebanon started
teaching dentistry. Soon I became chairman of the Fixed Prosthodontics department, and in 1984 was appointed as the
founding director of the dental school at the Lebanese University. In 1990 I moved to Jacksonville, Florida and started
my dental practice and the search for the optimum management system.
Opening three consecutive dental offices, starting
a dental Prosthodontics department, heading the founding team of a new dental
school and experiencing dentistry in Lebanon, France, and the U.S. gave me the
opportunity to learn, in diverse environments, how to implement new ideas
through team efforts. But it also left me with many unanswered questions on
management and leadership.
To find the answers, I have studied any information
I could find through books, audio and video-tapes. I chose Lean Management
because of its track record at Toyota. It appealed to my desire to apply to management
the same scientific logic used in dental treatment. In March of 2007, we presented our work at the Shingo Prize Conference
and were awarded the title of “World’s First Lean Dentist” by the Utah State
University and by the people in charge of the Shingo Prize for Manufacturing
My current Lean-oriented activities revolve around perfecting
the concepts described in my new book, Follow
the Learner: The Role of a Leader in Creating a Lean Culture. With the Lean Enterprises Institute’s help we tried
to summarize the journey, the experience and the thought process that led to
our implementation of Lean in dentistry. Originally, we had targeted the Lean
practitioner who, like me, had learned Lean and tried to implement it, with or
without success. After the first draft, we decided to keep the content, but
simplify the text to make it accessible to the Lean beginner.
As for the size, we ended up with 88 pages although
our goal was 60-70 pages. Why a small book? Two reasons. First, because most
management books are bought but not read— possibly because of their size. We
wanted every employee in every company to read the book in just a few hours and
be able to implement some of its ideas immediately. Second, because we wanted
to write a lean book on lean. Only what is necessary and sufficient. No words muda. No ideas muda.
Our final challenge was to make it clear that the
book is not exclusively about dentistry, but about Lean in any industry. We
hope to have achieved those goals, and that others would learn from our
experience; and mainly, that they would help us to improve our approach.
Today, our activities cover four fronts, 1) Perfecting
the dental management system. 2) Refining our message to our dental colleagues 3)
Communicating with service industries to show that Lean applies to their
businesses to the same degree as manufacturing and 4) Communicating with manufacturers
to tell them:” If Lean applies to the dental office, don’t tell me that it
doesn’t work in your manufacturing
2. How, when, and why did you get introduced to Lean and what fueled
and fuels the passion?
In 1993 I read the book Kaizen, and got attracted
the Lean philosophy. But the real eye-opener was Lean Thinking by Womack and Jones. Jim Womack tells the story of
his daughters folding their mother’s newsletters. “…why don’t you finish one at
a time?” He asked them. “Because it wouldn’t be efficient” they answered. In
1984, while in charge of the dental school, I had had the same idea, treating
one patient at a time. But I dismissed it:” Dental schools have been around for
a long time” I thought, “People must have tried it and failed.”
The dismissed idea was revived by Lean Thinking. I went to the
bibliography in the book and studied Ohno, Shingo, and others. Then we learned
the different Lean tools and applied them to dentistry. In 2005 we finally
reached the long awaited performance breakthrough.
What has always fueled the passion? The desire to
find the truth—true solutions to real problems. Isn’t that the premise of all
scientific research? And when the present state of science fails to explain
something, we turn to spirituality and faith to know the truth. I want to find
the truth about leadership, management, and dental care. I know that the truth is relative, and
multifaceted, but, imperfect as the concept is, only that pursuit will lead us
to finding true solutions to our patients’ problems.
do we get in return? A sustainable competitive advantage, very difficult to
copy, especially by a competitor focused on the practice’s efficiency and
productivity instead of the patient’s well being.
3. In your opinion what is the most powerful aspect of Lean?
Its inclusiveness—no person or idea is excluded, as
long as they contribute to process improvement. Sometimes I find it difficult
for a new management system to emerge separately. Lean would have no problem
including it, and using it for process improvement. It is impossible to predict
the future, you might say, and I have to agree, but that’s how far I can think
One aspect of this inclusiveness is Respect for people; an insider, an outsider,
a CEO or an assistant or a supplier, everyone is welcome to improve and help
Another aspect is Respect for ideas, wherever they come from. You can borrow from Six
Sigma, TQM, the theory of constraints, as long as you improve the process. You
want to use a control chart? Reengineer a whole value stream? Just prove that
it works and you can integrate it. Including ideas from other disciplines will
only strengthen a business’s adherence to Lean principles. An idea is evaluated
only by what it brings to the system.
4. In your opinion what is the most misunderstood or unrecognized
aspect of Lean?
One aspect cost me many years to
understand — the waste elimination trap and how flow can save us from it.
We learned that waste needed to be
eliminated; we looked around us for any of Ohno’s seven wastes and removed
it—for 13 long years. What did we get? Only marginal improvements! The problems
did not change. We were still running hours behind schedule every day, and
resources were drained uncontrollably.
Today, when I visit companies
trying to implement Lean production, I find them falling in the same trap:
worshiping removal of the seven (or eight, or nine) wastes, and their
elimination from their existing “batch and queue” systems. They can spend their
entire professional life doing it, but they won’t see tangible results unless
they switch to flow production.
Removing waste is very important,
but the time you spend analyzing it does not add any value to the product. Can
we minimize the analysis time? Yes, by implementing flow. Isn’t that what
Taiichi Ohno did when he started experimenting with TPS some sixty years ago?
When you watch a product, or
patient treatment, going through its value stream, it is either flowing or not.
Two possibilities are easier to control than seven. To take advantage of that
simplicity, we have created the position of a Patient Care Flow Manager; she watches all patients in the chairs,
for flow or no flow. If she sees obstacles to the flow of treatment, she
removes them. That would need analysis too. That analysis is a necessary waste
that we accept it as long as it eliminates the root cause of the problem.
Analyzing waste and eliminating it
in a “Batch and queue” system comes from the “time and motion study” era. Where
is it weak? We could be analyzing and improving unneeded operations. Starting
from flow eliminates most of those operations, and the time we would have spent
analyzing them. So we need to flow the patient through the system first, then
we can analyze and remove the forms of waste that stand in the way of a better
Let me take this opportunity to discuss the crucial
distinction that we make between flow
and one-piece flow. Although they are
often used interchangeably, my experience tells me that, from a practical standpoint,
understanding that difference is essential to the long term success of a lean
transformation. When we say one piece, we are quantifying our goal. Limiting the
number to one, adds the much needed rigor to the concept of flow. Just talking about flow seems too lax. It could be a
two-piece flow or a fifty or a thousand-piece flow. But, aren’t those batches? Whatever
the size of the batch, we might be tempted to be complacent and think that our
processes are flowing. A one-piece flow
ideal makes it simple, as long as you are flowing more than one piece at a time,
you need to make more efforts to reduce the number of those pieces.
As far as I know, One-piece flow has never been totally reached anywhere, which makes
it like perfection—unreachable, but good at guiding our improvement efforts—a
true north. We try to reach one-piece
flow, but we end up flowing more than one piece at a time, and that’s what
we call Flow.
5. In your opinion what is the biggest opportunity for Lean in today's
world? How can that be accomplished?
There is an immediate opportunity,
and long term one.
The immediate opportunity is Healthcare,
because it is expensive, and because it is getting a lot of attention lately. We
need a campaign similar to the Training
Within Industry (TWI) program in WWII. Healthcare institutions and providers need to learn Lean,
through TWI methods probably, and use it to improve healthcare delivery.
Delivery should be the focus for cost cutting and for quality improvement. I can
imagine two stages. First we need to learn how to flow patients through our
systems. Their stay in the system should be equal to the treatment time, no
more (for cost control), no less (for quality control). The treatment time is
subject to many variables, but we can ignore them as long as providers spend with
patients just the length of time they need for good quality. The second step
would be to continuously improve and shorten the treatment time itself, through
The long term opportunity is to
teach Lean to the entire society. I would start teaching it at schools, as
early as possible. As lean practitioners, we know it works in every aspect of
life, so why not teach it in every aspect of life. Professionals graduate with
very little management knowledge; doesn’t that need to change?
The global market is seeing many
emerging nations rely on Lean production. To stay competitive our children need
to learn management, efficient production, and leadership skills. The earlier
we start teaching Lean, the faster we could unlearn batch thinking.