2. Lean Concepts for the Dental Office Erin Norris-Muller Danaher Corporation

3. Page 2 August 11, 2005 Company Confidential a leading industrial company, designs, manufactures, and markets innovative products, services and technologies with strong brand names and significant market positions. Approximately 80% of Revenues from 6 Strategic Platforms Dental

4. Danaher Brands

5. THE BEST TEAM WINS CUSTOMERS CUSTOMERS TALK, WE LISTEN DANAHER KAIZEN IS OUR WAY OF LIFE DANAHER BUSINESS SYSTEM INNOVATION DEFINES OUR FUTURE WE COMPETE FOR SHAREHOLDERS QUALITY DELIVERY COSTINNOVATION

6. Danaher Core Values Continuous Improvement (Kaizen) is our way of life The Danaher Business System IS our culture. We aggressively and continuously eliminate waste in every facet of our business processes.

7. Waiting zzz zz Over- Processing Sign-offs Transportation 12 1 10 9 8 6 4 13 2 3 11 5 7 Unused Creativity No way! Motion Inventory Quality Defects Wrong info Info missing Keypunch error Over- Production What are the Eight Wastes?

8. Causes of Waste Functional organization IS technology gaps Excessive controls Outdated process design No back-up/cross training Unbalanced workload System batching Outdated policies Changing priorities Responsibilities not defined Poor visual control Disorganized workplace Lack of training Obsolete forms No SOP’s Authorization levels

9. DBS tools Strategic Planning Policy Deployment Value Stream Mapping 5S/Visual Management Standard Work Cooperative Business Planning Value Selling Voice of the Customer Danaher Development System Strategic Supplier Integration Production Preparation Process Transactional Process Improvement Problem Solving Variation Reduction Kaizen Six Sigma Design for Six Sigma

10. DBS tools Strategic Planning Policy Deployment Value Stream Mapping 5S/Visual Management Standard Work Cooperative Business Planning Value Selling Voice of the Customer Danaher Development System Strategic Supplier Integration Production Preparation Process Transactional Process Improvement Problem Solving Variation Reduction Kaizen Six Sigma Design for Six Sigma

11. Benefits of DBS Reduce redundancy in work Reduce errors in quality of information Improve efficiency Reduce time spent waiting for others Reduce time/distance spent walking Create standard work for all to follow Reduce amount of communications needed while improving quality of the communication itself Consolidate amount of places for storing information

12. 30’ 20’ File Hard Copy Pickup Next Order @ Fax Enter Order And Print Hard Copy Daily Requirement: 40 Orders Associate performs 3 tasks to complete 1 order Feet per (8 hour) day ____________ Feet per (5 day) week____________ Feet per (240 days) year ____________ Miles (5280 ft.) per year____________ Hours (Miles/2) ____________ Distance Exercise

13. 30’ 20’ File Hard Copy Pickup Next Order @ Fax Enter Order And Print Hard Copy Daily Requirement: 40 Orders Associate performs 3 tasks to complete 1 order Feet per (8 hour) day ____________ Feet per (5 day) week____________ Feet per (240 days) year ____________ Miles (5280 ft.) per year____________ Hours (Miles/2) ____________ 4,000 20,000 960,000 181 90.5 Distance Exercise

14. Waiting zzz zz Over- Processing Sign-offs Transportation 12 1 10 9 8 6 4 13 2 3 11 5 7 Unused Creativity No way! Motion Inventory Quality Defects Wrong info Info missing Keypunch error Over- Production What are the Eight Wastes?

15. Reducing waste 5S/Visual Management and Standard Work DBS tools Advances in caries detection and digital x- ray technology

16. What is Standard Work? Its not about working harder Its about working smarter What’s working smarter? Being able to accomplish the same amount of work in less time. Giving the customer what they need. Its not about working harder Its about working smarter What’s working smarter? Being able to accomplish the same amount of work in less time. Giving the customer what they need.

17. Continuous Improvement = Change Everything we do is part of a process… …all processes can be improved inputs process output

18. Determining What is a Noise and What is a Constant NOISE Something that we do not control today or may vary CONSTANT Something that we control today or does not vary BRAINSTORM WAYS TO CONVERT NOISES TO CONSTANTS – CREATE SOP’s

19. Level 1OKSomething on Paper Document current process Level 2BetterChange to the process Identify and attack waste Level 3BestIrreversible change to the process / Poka-Yoke Error-proof the process We want to strive to achieve SOPs that are Level 3 NOISE: Some orders are received with incomplete information Levels of SOPs

20. Standard work should be: A precise description of each work activity. Created and documented by stakeholders Always followed by everyone performing the work Revisited and refreshed every 90 days Owned by someone Standard Work Guidelines

21. Exercise 1 2 3 4 5 6 7 8 9 10 11

23. DBS Tools – Visual Management 0 1000 2000 3000 4000 5000 6000 7000 8000 0120 110 100 90 80 70 60 50 40 30 20 10 Oil Battery Gasoline E F Tachometer MPH Odometer Trip-O-Meter 00236 Brights Air Conditioning Heat Lights Defroster TAPE CD 90.55FM

24. DBS Tools – Visual Management BALL: STRIKE: PITCHER: ERA: W-L: K’s: BB’s: OUT: #37 RF.279 12 43 #42 3.59 11-7 5 1 3 2 ON BASE 2 VISITOR 001010204 7 0 HOME 1000030046 1 AT BAT: POSITION: AVG: HR: RBI: INNING123456789R H E Would you stay for the end of this game?

25. Visual Management allows us to know what is happening when walking into a situation. The team you were cheering for scored home runs! Did you stay to see it? DBS Tools – Visual Management

26. Principles of visual management Three second rule A picture is worth 1000 words Color coding One page

27. Is this Good Visual Management? You approach a crosswalk at a stoplight and see these signs:

28. Contents of Instructor Kit

29. Visual Management Next step operatory Owned by Lead Assistant & Office Manager

30. X-ray set up Paper towel Sensor Sensor sleeve Finger cot Bitewing tab Snap-a-ray Mask Edge-Ease IOC Camera sheath Blood pressure cuff

31. Visual of “Proper Workstation Set- up posted in each x-ray room

32. What is 5S? 5S Is: 5S Is: – A process to ensure a clean, orderly, safe and productive workplace.

33. What are the 5S’s? ¶ S implify ¶ S implify (Seiri) · S traighten · S traighten (Seiton) ¸ S crub ¸ S crub (Seiso) ¹ S tabilize ¹ S tabilize (Seiketsu) º S ustain º S ustain (Shitsuke) Clearly distinguishing between what is necessary and what is unnecessary and disposing of the unnecessary. Organizing the necessary items so that they can be used and returned easily. Cleaning floors, equipment, and furniture in all areas of the workplace. Maintaining and improving the standards of the first three S’s. 5S Achieving the discipline or habit of properly maintaining the correct 5S procedures.

34. SIMPLIFY Identify Truly Needed Items –What is it for? –Why do I have it? –How often do I use it? –Does someone else have the same thing? Clearly Distinguishing Between What is Necessary and What is Unnecessary and Disposing of the Unnecessary

35. STRAIGHTEN Proper Locations Proper Locations Storage Methods Storage Methods Location Marking Location Marking Shadow Boards Shadow Boards Sign Boards Sign Boards

36. STRAIGHTEN

37. SCRUB Cleaning Floors, Equipment, and Furniture in all Areas of the Workplace Cleaning Floors, Equipment, and Furniture in all Areas of the Workplace Establish a Clean Workplace. – Clean up the Area. Ü Sweep & Wash Floors Ü Clean in, under, and around Equipment and Furniture Ü Eliminate all Trash from Workplace –Keep in mind: How do things get dirty? - Fix the root cause of the dirt.

38. STABILIZE Maintain and Improve the Clean, Organized Workplace Maintain and Improve the Clean, Organized Workplace –Eliminate excess storage areas and flat surfaces –Make changes to equipment that make it easy and quick to clean and eliminate dirt and leaks at their source –Use check list to establish daily cleaning and organization activities 5S5S –Institute 5S Patrols to monitor 5S progress Maintaining and Improving the Standards of the First Three S’s

39. SUSTAIN D ANAHER B USINESS S YSTEM Develop a Habit of Simplifying, Straightening, Scrubbing and Stabilizing Your Workplace Develop a Habit of Simplifying, Straightening, Scrubbing and Stabilizing Your Workplace Everyone Has to Accept 5S as a Personal Goal Everyone Has to Accept 5S as a Personal Goal People Follow Examples (Good and Bad); Set a Good Example People Follow Examples (Good and Bad); Set a Good Example Achieving the Discipline or Habit of Properly Maintaining the Correct 5S Procedures

40. Conventional Detection Method If surface caries, the explorer sticks If no stick, assumption is no carious lesion But see what the Dr or Hygienist Doesn’t?

41. Versus Other Methods? Source: Lussi et al., Quintessenz 54, 10 (2003)

42. Diagnodent Changes the Way We Detect Caries Scans below the surface Basically it is a “Three Dimensional Explorer”

43. The principle of fluorescent iridescence A tooth surface fluoresces when irradiated by a light of a given wavelength This fluorescence changes according to the optical characteristics of tooth tissue, associated with bacteria. The value of this change may therefore give an indication of the extent of the disease process

44. DIAGNOdent LASER specification TypeSolid State (Diode) Light Output< 1 mW Wavelength655 nm (latterly 652 nm) Voltage7.5 V (5 x 1.5 V - type AA) ClassificationClass 2

45. The principle of DIAGNOdent Light is emitted from the solid-state LASER, at a fixed wavelength The probe tip incorporates two-way fibre optic bundles The incident LASER beam is carried by the central fibre optic bundle and the reflected LASER beam is carried by the peripheral bundles

46. DIAGNOdent mode of operation 0512 LASER Emission Fluorescence Transmitter & Receiver Electronics Loudspeaker Digital reading Moment / Peak

47. DIAGNOdent digital display “MOMENT” display gives the current real- time value being measured as it continuously changes from second to second “PEAK” display gives the maximum value recorded during any single tooth measurement DIAGNOdent will switch off automatically if not used for more than approximately two minutes

48. What do the values mean? Research has shown that it is possible to correlate values with disease progression (Lussi et al, 1998; Longbottom et al, 1998; Reich et al, 1998). From this work it would appear that: values between 0 and 10 correlate with sound enamel values between 10 and 20 correlate with outer enamel caries values between 20 and 30 correlate with lower enamel caries values over 30 correlate with dentinal caries

49. Dental x-ray technology

51. 66% reduction in steps 80% reduction in time