Lightspeed orthodontics by avoidance of bottlenecks with the pull principle (Kanban)

Avoiding bottlenecks can be a challenge in any production system including orthodontic practices. By implementing the Pull-Principle, you can keep treatment and waiting times flowing and organize your appointments optimally. Waiting time is a “muda” or waste that causes bottlenecks in your system. A pull system is a lean manufacturing principle that is used to reduce this waste in the production or service process.

By observing and consciously altering your queue states, you can keep track of waiting times and reveal your process bottlenecks right away. Kanban pull systems help significantly improve productivity and decrease delivery times.

Why is the pull system better tahn the push system?

Pull systems are a part of the lean manufacturing principles born in the late 1940s from the Toyota Production System front. Unlike a push system, where work is pushed onto the respective teams regardless of their capacity, the pull system prevents the overburden of the teams and optimizes the workflow.

The basic principle of the pull system is to build products based on actual demand and not on forecasts. This means that the team gets started on new work only when there is customer demand for it. This allows you to reduce overhead, make brilliant use of the resources, optimize storage costs, and avoid overstocking which can inevitably cause an imbalance in unexpected financial requirements.

Examples of the pull system

Consider this: It’s a Friday lunchtime and you have a long afternoon with patients ahead of you. You have planned 30 minutes during your lunch break to get up to speed with your shopping. You are super-efficient, have a shopping list, run dynamically with your shopping cart from shelf to shelf, and are satisfied with how quickly you do it. Everything runs smoothly!

But when you arrive at the check-out, only two of the four cashier counters are open. Which one do you take? Which one is faster? Of course, with your remarkable observation, you will come to the conclusion that you’ll choose the cashier counter that has the least number of trolleys parked in front of it, also taking into account the cashier’s speed of scanning.

Now apply this supermarket checkout illustration to your practice. Double the number of shopping carts in front of the checkout means double the waiting time. If transferred to production, this means that twice as many semi-finished orders or products in production lead to a doubling of lead time.

You can observe bottlenecks everywhere:

• A construction site on the highway that‘s causing a traffic jam,
• A machine in industrial production with a defect
• A phone call which the lady at the reception accepts and which seems to take forever, as customers line up eagerly waiting for their turn

It is important to pay particular attention to these bottlenecks in the course of your practice because the bottleneck within a value chain determines throughput. Or in other words, the overall system only functions as well and as quickly as the strongest limiting factor within this system: the bottleneck. So, find out where and what kind of bottleneck you are dealing with in your practice and eliminate it immediately.

That being said, the solutions that work for one company may not necessarily work for another. Opening the third checkout can significantly reduce traffic bottlenecks in the supermarket scenario but may not proficiently eliminate problems in your orthodontic practice when you are restricted with limited personnel. All in all, the pull principle, called Kanban in Japanese can essentially control the value chain in such a way that it optimizes every stage of production if only used precisely.