The Assembly Line

Henry Ford is considered a genius by anyone’s standards.  He didn’t invent the automobile, but he perfected a way to manufacture the car, so that it became affordable for most Americans.  Ford had to work within certain quality standards; after all, the safety of the American public was at stake.  Ford’s system, the assembly line, has become the standard in the world of manufacturing.  Ford himself might not recognize today’s versions of the assembly line, but he would certainly recognize a concept of interdependence in everything that is produced in the world of work.  Henry Ford had a vision, to make automobiles affordable for all Americans and from that vision he left his legacy.

Many of us are turned off by the idea of an assembly line when it comes to health care.  No one wants to be treated like a part.  Ford was dealing with inanimate objects that had very human implications.  The point is that the assembly line is less about what is being assembled and more about the process of designing, building and assembling.  No matter what we are trying to create, it always involves a process.  Success will come to those who understand that process.  Any vision can be reached if one pays attention to the process.  We think in terms of oral health, or restorations, but I will challenge you to believe that your business and life itself is more dependent on vision and process than anything else.

The more complex the thing you are trying to create, the more dependent you will become on other people.  That dependence and interdependence leads to the concept of the assembly line.  Think about the new patient who requires complex multidisciplinary dentistry.  This is sort of like a puzzle.  Go into any novelty store and pick up a few jigsaw puzzles.  You will notice that they are categorized by their complexity or number of pieces.  The simple ones are inexpensive and don’t take very long to complete, but those ten thousand piece puzzles are going to take a lot more understanding and may require a team approach.

In putting a puzzle together we usually start with some guiding parts, the straight edges and the corners.  These are our starting points and our vision can be seen right on the cover of the box.  The vision is what drew you to buy the puzzle ñ that beautiful picture of the cat that looks just like your little Puffy.  It’s the vision that drives us.  It’s the vision that helps guide the process.  That is what drove Henry Ford.

In the real world, we don’t have unlimited time to put together the puzzle.  People want results and they want them without any delays.  Once they become convinced that they want what the dentist has helped them to visualize - they want it now.  That is why process becomes so important in order to produce the predictable vision.

The other morning I received a call from a laboratory technician.  He was having difficulty designing a case I had sent over to him.  It was an implant case and he was having difficulty aligning the abutments to accept crowns that would be in proportion to the rest of the mouth.  I imagined the assembly line.  On that morning he had to pull this case off of the line and call me.  We discussed the case and agreed the only thing to do was to wax the case and possibly create Plan B.  When I received the wax up I would consult with implantologist.  In manufacturing terms, a bottleneck was created, and nobody likes bottlenecks.

Bottlenecks slow down production.  People get angry.  Quality goes down as the pace of production adjusts to the slow down.  Think about the classic television episode where Lucille Ball gets behind while she’s packaging candy.  It looks funny but in real life those things can get awfully stressful.  So many dentists want their laboratories to get their cases back in amazingly short periods of time.  Many laboratories try to comply.  They run the assembly line so fast that errors occur.  Bottlenecks kill production and morale.  Work backs up and people come off the line to help out in other departments where they don’t have expertise.  The case gets back to the dentist late and he or she has to answer to the patient.  We have all been there.

The dentist gets angry at the laboratory.  The laboratory tries to appease by compromising and the quality goes down.  That is why a well-run assembly line is so important.  Let’s get back to the implantologist for a second, because he too is on the assembly line. His work can help the process flow along or create a bottleneck too.  We all get over these things but in the end, because of the interdependent nature of our work, relationships suffer as much as the quality.  We never reach our vision.

How can we fix bottlenecks that continually threaten our day-to-day operations?  Is there a system that can be used that will keep the multidimensional assembly line moving?  Is this a question for management?  I don’t think so!  The answer to the problem comes with communication through excellent leadership.  My laboratory technician pulled the case off of the line and took the time to call me.  I was receptive to his call and took it in a constructive manner.  I need to do the same thing with my specialist.  Open communication can cure these chronic problems that haunt our profession.  Too many of us look at the assembly line and say that we can make it work.  Where would the automobile industry be with that attitude?  The laboratory tech, the dentist and the specialist are equal cogs on the assembly line; this must be understood.

Is there a vision for dentistry?  Is it too unreasonable for us to think of a world where everyone has optimal dental health, or the access to it?  Can we all imagine a world, like Henry Ford did, where every American can own a car?  I think we can imagine it, but I am a realist and maybe optimal dentistry isn’t for everyone, like cars.  But I do have a vision where optimal dentistry is offered to everyone.  I believe that vision, is achievable and we are very far away from that vision in America today.  I believe that we can only offer people our very best, high quality and even affordable dentistry if we all get on the same page.  It starts with the examination and the full realization that everyone connected to the result the specialists; the laboratory technicians, the assistants and the hygienists are all on the assembly line.