The Lean Practice Coach

Many times in life we are presented with a problem for which we need to get to the root cause. One technique for arriving at the root cause is called the five why’s. If you ask the question “why” repeatedly you will come to the root cause. The number five is a good rule of thumb for the number of times you will need to ask “why?” to arrive at the root cause. This is a very simple tool to use, one that does not require a data collection plan, and it easy to complete without any statistical analysis. I recommend that you follow these set of steps to utilize the five why’s method.

1. Write down the problem. Grading down the specific problem helps you to describe it completely; it also helps the team to focus on the specific problem.
2. Asked why the problem happens, and write the answer down below the problem.
3. If you have not identified the root cause for the problem you specified in step one, ask why again. Write that answer down.
4. Repeat step three until you or you and your team agree that you have arrived at the root cause. This may take more or less than five why’s to accomplish.

Problem Statement: You are on your way home from work and your car stops in the middle of the road. (I borrowed this example…)

1. Why did your car stop?

– Because it ran out of gas.

2. Why did it run out of gas?

– Because I didn’t buy any gas on my way to work.

3. Why didn’t you buy any gas this morning?

– Because I didn’t have any money.

4. Why didn’t you have any money?

– Because I lost it all last night in a poker game.

5. Why did you lose your money in last night’s poker game?

– Because I’m not very good at “bluffing” when I don’t have a good hand.

As you can see from this example, using the five why’s has allowed the team to arrive at a root cause that can be acted upon. It is much easier to work on root causes than it is to work on symptoms.

One of the main objectives of leading practice management is the elimination of waste. There are several types of waste that have been identified: over-production (making too much), motion (of doctor, patient, assistant or machine), waiting (of doctor, patient, assistant or machine), conveyance (movement of people or objects), inventory (materials), and correction (rework and scrap). Today’s post focuses on the motion of doctors and patients.

Recently, I was in a doctor’s office where the treatment rooms are located in the corners of the office, as far away as possible from the front desk. This Doctor had the habit of walking each patient back to the front desk while talking to them. A quick back of the envelope calculation indicates that the Doctor walked about a mile every day escorting patients back to the front desk. This translates to 20 or 25 minutes of walk time. As it turns out, the office could be rearranged quite easily to reduce the walk time to nearly zero, thus saving the Doctor and the patients time and effort. This is an example of inefficiencies that are “built in” to a practice. If you look, these inefficiencies are everywhere.

Recently, I’ve been in a couple of practices that seemed “slow”. Part of the lethargy could be attributed to the temperament of the doctor, I’m sure. BUT the music that was on was also slow and lethargic. Neither office was busy and neither doctor seemed to know what to do to increase their business.

To build and increase practice volume and production requires sustained effort which requires energy. I will assert that part, but certainly not all, of the problem in these offices was the atmosphere that the music helped create. We all know that colors in the office are important, as well as layout and furnishings. We also know that the demeanor of the doctor and staff also are important. I think that some practitioners have neglected to thing carefully through their music selection. Instead of the calm and relaxing atmosphere they may have wanted, they got depressing instead. In one of the offices, one of the patients commented negatively on the music while I was there.

If you do a Google search on “music atmosphere restaurant” you can find articles that have quantified the inclination of patrons to spend more when the right kind of music was on. Googling “music atmosphere dental office” gets some hits on the same subject, but without quantification. In short, the restaurant article found that “Classical, jazz and popular music were associated with patrons being prepared to spend the most on their main meal.” [http://pom.sagepub.com/cgi/content/abstract/31/1/93]

In the café I frequent, they play classical and jazz. Upbeat, not slow. Happy not sad. They are busy.

I have one client who manages and plays the music in his office from his computer, via playlists and music ripped to his computer. He wants to make sure the music is appropriate and wants no commercials. If you want the technical details, please contact me.