The Group Dentistry Now Show: The Voice of the DSO Industry – Episode 221

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Welcome to The Group Dentistry Now Show: The Voice of the DSO Industry!

In this On the Road episode of the GDN Show, we visit Midmark’s Experience Center in Versailles, OH, where we sit down with Michael Couch, Director of Marketing & Dental Solutions at Midmark, and Kate Reinert, LDA, Clinical Efficiency Consultant at Zirc, to discuss:

• Evidence-based practice design
• Clinical flow & patient journey
• Standardizing inventory management

To learn more visit https://www.midmark.com/dental

To visit Midmark’s Experience Center https://www.midmark.com/dental/design-center/the-midmark-experience

You can find Michael Couch on Linkedin – https://www.linkedin.com/in/michael-couch-76789412/

To learn more about Zirc you can visit – https://zirc.com/

If you would like to get organized, boost productivity & simplify your workflow, schedule a demo here – https://zirc.com/pages/color-method

You can find Kate Reinert on Linkedin – https://www.linkedin.com/in/kate-reinert-lda-0b3246a8/

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On The Road with Midmark & Zirc DSO podcast transcript:

Welcome to the Group Dentistry Now Show, the voice of the DSO industry. Join us as we talk with industry leaders about their challenges, successes, and the future of group dentistry. With over 200 episodes and listeners in over 100 countries, we’re proud to be ranked the number one DSO podcast. For the latest DSO news, analysis, and events, and to subscribe to our DSO weekly e-newsletter, visit groupdentistrynow.com. We hope you enjoy today’s show.

Bill Neumann: Welcome to the Group Dentistry Now show. I’m Bill Neumann, and we are on the road in Versailles, Ohio at Midmark’s corporate headquarters. And we are actually going to explore the Experience Center. Michael Couch with Midmark is with us, as well as Kate Reinert from Zerk. Thank you, Michael, for the invite. This is going to be great.

Michael Couch: Bill, we’re really excited to have you. Kate, it’s awesome to see you, as always. Really want to really take us this morning into our Experience Center, really help you experience not only our beautiful campus, but what the Experience Center is all about. So why don’t you come join me this morning? Let’s go.

Bill Neumann: Welcome everyone to Midmark’s Experience Center. We’re really excited to be here in Versailles, Ohio today. I’ve been here several times and it’s really, it’s a fabulous place to be and I think you’re going to get a real good feel for what it’s like to actually be here in person. And if you stick around till the end of this video podcast, which you better, you can actually find out how you can come here in person, visit the center, and really explore things. So we’re going to take some time now with Michael Couch. and Kate Reiner and have a discussion about what you see here in the Experience Center. And then also we’re going to talk about planning efficiencies. We’re going to talk about the future of operatory design. We’re going to talk about sterilization centers and a whole heck of a lot more. Michael, first off, thanks so much for the opportunity to be here. I think the audience is going to learn a lot. And what I would say also, by the way, if you are listening to this podcast, you’re not gonna get the full experience. So jump on over to the YouTube channel or groupdentistrynow.com and actually watch the video so you can learn exactly and see what we’re talking about here. But Michael, he is the Director of Marketing here at Midmark’s Dental Division. Thank you so much. Michael, a little bit about your background and then can you tell us about the Experience Center?

Michael Couch: Yeah, no, I really appreciate that, Bill. And thank you for being here. Thank you, Kate, for being here as well. Just a little bit about my background, and maybe let me step back and talk a little bit about the organization. If you walk into the building, one of the things you’re going to see as soon as you walk into the door on our front wall is we design. And at the end of the day, ultimately what you see, and we’re going to talk about here this morning, is we design better care. And you’re going to see that woven through the conversations. You’re going to see that woven through the experience center. A little bit about my background, it’s a little unique. So I carry two additional certifications that are really important for my role as a director of marketing, but also the work that my teams are working on on a regular basis. So number one, I have an EDAC certification. It’s evidence-based design accreditation. Why is that important? Well, the evidence-based design methodology is akin to evidence-based medicine. I’m going to look at observational data. I’m going to look at other data analytics to figure out what are the things that we can do to optimize the outcomes that are happening in a clinical space. And it’s not just the things that we produce. It’s also about the space. We’re in a beautiful space. But at the end of the day, we need to take all of those aspects and bring them together. And that is one of the major aspects of the evidence-based design methodology. Number two, I’ve been a LEED AP since 2008. LEED is Leadership in Environmental and Energy Design, United States Green Building Council. So if you go in a lot of modern buildings, even government buildings, you’ll see plaques on the wall. And it’s really about the holistic design of the building. And really why that’s important is In many cases, you think about sustainability, you think about intuitively the materials that go in there and what can we do to reduce, reuse. We worry about VOC and off-gassing and all the rest of that stuff. But LEED is bigger than that. And sustainability is bigger than that. And at the end of the day, if I understand how we can impact the built environment through both evidence-based design and concepts like LEED, we ultimately can have a better outcome in the space. I can design better efficiency for the space and the usage of the space. And that’s going to be one of the topics that we’re going to have to discuss today, I hope. So really excited about what that brings. A little bit about this space, though, if I may. This space ultimately was a collaborative effort. We used to have a building literally right over here in the grass. And when we had the opportunity to build our new campus, we wanted to change what an experience should or could be in the future. So this space is now double the size that it used to be. And at the end of the day, this is not a showroom. This is an experience center. This space is about bringing people here to really collaborate, rethink. We purposely have dental vignettes next to medical vignettes, next to veterinary health vignettes, because we want people to go across different workflows and challenge themselves on how they can rethink their space and their outcomes for the future. And so to me, that’s a really cool aspect that we bring to this space. This is ultimately about challenging what is today and what should it be for the future.

Bill Neumann: I think you’re foreshadowing a little bit about a question we have later on, talk about the future of the industry and the future of practice design too. And I think having access to, you know, the medical side of things, which, you know, there’s a lot of talk about medical dental integration and you probably see it here a lot because you’re dealing with medical customers as well as dental customers. Yeah, so we’ll talk about that later, but it’s very, very exciting. And you’re right, it is an experience center. It’s also the corporate headquarters, right? So you’ve got the corporate side of things, but then you’ve got your experience center here all in one building. And when was this building built?

Michael Couch: So in the middle of coven we were actually building this so if you can imagine and you know 2020 2021 and you know we have teammates coming in here in the mass and we’re doing the temperature checks and all the rest of that stuff. You know our engineering space literally right down the hall, we had our first teammates. Occupying that space and then we gradually brought in the rest of the teammates into the new area so in that time frame is where we we fully opened. So it’s really an awesome space and even it’s been a continual journey, so what I mean by that is, you know, this year we’re celebrating our hundred and 10th anniversary. So it’s a really cool year for us. But throughout that whole thing, we’ve been constantly thinking about how we can reinvent ourselves. Even the drive that you drive up on to the front entrance, that was just finished here recently. So all of these things have been small little iterative changes to get us to where we’re at today.

Bill Neumann: And again, it’s really hard to explain the experience here unless you see it. So again, if you’re listening, you’ve got to watch the video, or even better yet, come out and check things out. Yeah, that’s great. And you also, before, and I want to introduce Kate as well, but You have a lot of visitors here. It’s not like this is just the corporate offices and then the experience center that people come in every once in a while. Every time that I’m here, there are multiple groups of people here. And sometimes it’s actually hard to kind of get fit in because their schedules get really packed up. So whether it’s an emerging group or a larger DSO or you’ve got a course going on, there’s a ton of activity here all the time. So, Kate, I don’t want to leave you out. Kate Reiner, she is an LDA, licensed dental assistant. I learned that today from Minnesota. She’s with Zerk. And Kate, a little bit about your background and maybe talk a little bit about Zerk and the partnership you have with Minmark.

Kate Reinert: Absolutely. Well, again, thank you for inviting us today. I, like you said, I’m Kate Reiner. I was a licensed dental assistant for 18 years before coming over to Zirk Dental Products. You talked about the evidence-based design and I actually, I am the evidence, right? I got to be in the clinic. I got to be the one that was living it day to day, seeing the patients, working through those challenges and successes and whatnot. It was a great journey to go from clinical time frame into the consulting side of things with Zirk Dental Products. It was a very easy transition because I’ve always wanted to share my passion for elevating patient care. And at Zirk, that’s what we’re here for. We’re here to help clinicians perform better so that they can provide better patient care. So it was a really easy transition for me to move over. And Zirk dental products, it’s not just dental products. We have been around since the 60s and it all started with a friendship of Jim Campion with a friend who was a dentist and he needed some solutions and he’s always been very solution-oriented and that’s come very full circle for us as we are starting our consulting side of things. During the pandemic we recognized that people needed to do things differently and they needed support in doing that and that’s where our consulting or a color method product line really came to fruition when it came to that. So we get the opportunity to help dental practices be more efficient, bring in easier workflows into their practices. And that’s something that we’re very passionate about because all of us consultants, we have clinical backgrounds, we’ve walked in those shoes, we’ve been in those experiences, and we definitely wanna be able to help these clinicians, again, at the end of the day, just provide better patient care.

Bill Neumann: Can we talk a little bit more about the partnership between Zurich and MedMart?

Kate Reinert: course, it was a really natural next step partnership. You know, Midmark has all this great cabinetry and they have great team members that are trying to tell the story of what is going to be in these cabinets. And that’s what Zerk does. We help you identify the needs of the cabinetry so that we’re being very intentional with what it is we’re putting in these places and making sure that we’re not overspending and over-ordering our product or the cabinetry. having that full intention behind it. And when you come here to the Experience Center, you’re going to see, you’re going to be able to sit in these spaces and actually see how it functions. How does Zerk’s tubs and trays actually fit within the space of these dental, of these treatment rooms?

Michael Couch: Yeah, let me just add one other thing. For us, I think one of the critical things that Kate and the team brought was not just the what, but it was the why. So many times people want to not just know, like, what do I need to put here, but why am I putting this here? And I think that was the beautiful part of this partnership is so much of our conversation is understanding that bigger clinical conversation of, I need to understand how this is going to impact that efficiency. I need to understand how this is going to impact the long-term outcome for this staff and this And I think that was a really critical aspect. One last thing for us that’s really, really important is we partnered not only here in this space, but also we partner in education. And so we have an impact design seminar. We have another one coming up here at the end of the year, but it’s really important that we are seen together because at the end of the day, it’s the ultimate combination of our solutions together that really have the biggest impact for both of our customers.

Kate Reinert: When we get the opportunity to work side-by-side in the field with our Midmark team members, they come to us and they say, we have this practice that we’re working with. Help me, help us figure out what our needs are. And they want to learn. They want to be able to be the best resource for their practices. So the Midmark team members are so receptive to what it is we’re teaching, because it’s only going to make the experience better for our customers.

Bill Neumann: And I think you can really build an efficient and help design an efficient operatory and efficient dental practice. But I think you need an efficiency consultant really to come in because you could design it and they may not necessarily know how to use it or implement that efficiency and take full advantage of that design. So it’s great that you have this partnership with us.

Michael Couch: Yeah, I think it’s really taking the best of both of our histories and our backgrounds and to take that efficiency aspect that Kate and the team were talking about. So it’s really cool to see it all come together as a holistic solution.

Bill Neumann: And actually, we talked about this off camera, but you you’re a clinical efficiency consultant and you’ve actually added a couple of people to your team, right? So you’ve got you’ve got several clinical efficiency consultants that are out there helping both solo practices and also emerging groups and DSOs. One thing I Oh, I really want to mention too, is both organizations are made in the USA. So Zerk is in Minnesota, manufactures their products there in Midmark. I mean, you do everything, you know, pretty much right here, right? I mean, it’s just amazing to kind of see that and it makes me feel good. Michael, let’s talk a little bit about the importance of clinical flow and the patient journey. You want to start that off?

Michael Couch: Yeah, that’s always a fascinating topic. For us, we really like to take a step back to understand what are the major goals for an organization if they’re working with Midmark. And we really like to get back to some of the fundamental basics. So if I’m going to look at things, I’m going to understand the role of the space. So, what are they looking at? And one of the things that we try to do is not just understand what’s going on, but then also provide potential solutions. So, you might have organizations where they just have an architectural floor plan and that’s what they’re going to stick with. Ultimately, at the end of the day, our role, we believe, is to really say, hey, there’s different ways maybe you should rethink this space. When we think about clinical efficiency, understanding, especially if it’s a de novo or a major remodel, this is gonna be something you’re living with the basic structure of for 15 to 20 years before you maybe do something major in a renovation. So that means you really need to rethink and challenge yourself up front to have a better outcome. So major areas for me that I really talk about with our teams and other areas, we look to separate flows. So, for instance, we have conversations around wayfinding, and I know that’s something that you’re really passionate about. You’re going to find some of the best in-class facilities are going to look at things that separate a clinical flow path. from a patient flow path. So if I can keep my staff in a separate space, it’s gonna provide better efficiencies and separate those zones, it’s gonna provide better outcomes. The other thing you look at is what’s gonna happen in the future. For me, understanding or predicting what the future is gonna be is, none of us are Nostradamus, we don’t have a crystal ball, so we don’t know what’s coming. But we can have a pretty good understanding of what we believe the next three to five years are gonna be. And what are the things that I need to make sure we’re preparing our facilities for? So as I think about that, what are the things that we can do in the design to streamline that process? What are the things that we can do to separate those flows? What are those common mistakes that we see? So for instance, if I’m bringing in a piece of technology, is that going to disrupt my flow or is that going to enhance my flow? So those are all major things for us that are really important. I think the other major aspect we think about is proximity. When we’re thinking about proximity, you need to understand what are the things that my team or myself are going to do as a clinician on a regular basis. If I designed a linear flow path that basically forces my staff or my team to walk hundreds of extra steps per day because that operatory, for instance, is all the way at the end of a corridor, and I can’t efficiently get back and forth to a sterilization space or to an imaging corridor, I’ve now built in inefficiency in the space. So are there things that we can do inherently in design to provide for better optimization up front?

Bill Neumann: The audience probably be interested, are there some common layout mistakes that you see and maybe some, you know, Kate, you can chime in too. I’m just curious about that, you know, layout mistakes. Do you see anything that, you’re trying to obviously help them out so they don’t happen, but a lot of times these groups are acquiring practices.

undefined: They are.

Bill Neumann: So they acquire something and in a lot of cases, maybe it was designed 10, 15, 20 years ago, or it was a building that was maybe, it was, storefront that was being used for something else.

Michael Couch: Yep. So I think major things that we would see on a more regular basis, especially in that example, there’s going to be what are the things that we can do to identify bottlenecks. So those bottlenecks that we see a lot of times are around those cross flow paths. That’s the reason I was talking about separating the flow paths wherever possible. So, for instance, you’re going to have an existing or, you know, a facility that you purchase, you’re probably going to have something that’s going to cause your staff to potentially be at a bottleneck. In many cases, it might be sterilization. You’re going to see people coming back and forth between operatories, and there’s a singular entrance potentially into a sterilization space. There may be multiple entrances. all of a sudden that becomes your bottleneck, where everybody crosses over. So what are the things you could do? Is there a slight modification to the design? Is there something you could do to provide a different entrance or a different flow in that space?

Bill Neumann: It doesn’t sound like a major thing, but it will… So that’s the best practice to have, you know, multiple entrances or entrance and exit to the sterilization.

Michael Couch: And by doing that, it also reinforces from a, compliance standpoint, best practice. I don’t want to have somebody going from a clean area back to a dirty area. So let’s keep it so the flow path is circular in nature.

Kate Reinert: And to add to that, you know, ideally, you know, a perimeter of treatment rooms, you have your central sterilization, just that central to where it is in the practice with that dual entry, allowing for those compliances when it comes to that, it’s going to be more efficient, less steps like you’re talking about for each, each person on the corners to get into that central sterilization. That’s definitely something that we see as a mistake that happens when it comes to the efficiencies or inefficiencies. So I would say for sure we need to have that central sterilization exactly where it is central. And then the storage space that goes along with it as well too.

Michael Couch: One of the other things, and I think this is an area that Zerk really shines, is so often we hear this conflict between aesthetics and efficiency. And so this is where I believe that there are real meaningful areas that we want to understand, like how we can have something that’s aesthetically pleasing, like those cool, calm colors. Those are really important, but we also want to see if there are things that we can do to really look at high contrast. So if I’m a clinician, I’m in and out of a space on a regular basis, whether it’s the equipment that’s in the space or the storage and other items in the space, I want to make sure it’s high contrast. If I can see it, it’s a higher likelihood I can make sure that I know what I’m grabbing the first time. So I don’t know if you want to add anything to that.

Kate Reinert: I would agree. I think that it’s important to have those quick decision-making opportunities where you’re not having to over-process what your needs are, what you are about to perform. I agree with you. I think that having that opportunity to have the quick visuals, less decision-making, less brain energy being wasted.

Michael Couch: We talk, the brain energy, a lot of times we talk whether it’s development of new solutions or existing facilities, what can we do to reduce cognitive loading? Like at the end of the day, one of the big topics you’re gonna hear across the industry right now is we need to make sure that we’re helping our teams do more with less. And so the ultimate at the end of the day, are there things that we can do to help them be more efficient in the space? And part of that is reducing that cognitive loading. If I have high turnover with less staff, what are the things that I can do to reduce steps, clicks, processes, to help them have a better outcome in the space?

Kate Reinert: And it’s gonna give them better patient care opportunities as well. When they aren’t exhausted mentally and physically exhausted at the end of their days from that decision-making, they’re going to be able to make sure that the lab cases get out right away. We’re gonna make sure that their chart notes are done. They’re not gonna leave the office going, what did I forget to do today? And then that’s just gonna create the speed bump first thing in the morning where they have to get all of these things done. And it comes down to they’re coming in earlier than to do these things. That’s more payroll that needs to be done before you know what, they’re getting into overtime. It all comes around those efficiencies that need to be performed in the practice.

Michael Couch: Yeah, so I could jump in here. Obviously, you know, we’re really proud of the operatory equipment and the spaces that we create. And as you’ll see here in this space, we really like to talk about ways that you can challenge that. To your point earlier, we have existing facilities. You have set walls. I can’t move those walls in many cases because of the items that are in the walls. It could be electrical, it could be plumbing. That’s not something that we can easily change. But there’s things that we can do even in those existing spaces to really provide a better outcome in that space. So when we look at those things, we really want to look at what’s going to happen in that space on a daily basis. Again, so many times when we work with organizations, we’re seeing that they’re so focused on what the workflow is today and what those first costs are. And really what we really need organizations to look at is what is the longer term objective, what is that next five years 10 years 15 years look like, because ultimately that’s your true cost that’s your long term costs that’s what it really needs to be focused on. So what are the things that we can do to really optimize that space so it could be looking at. Hey, do I provide a slightly wider doorway? Something as simple as that to provide better efficiency for getting patients in and out of the space without bumping into equipment, making sure that they feel comfortable and calm in the space, those type of things. Are there things that we can do to look at natural day lagging? I want a better patient experience. Something as simple as natural daylighting. We have this beautiful facility. Part of the reason all these operatories are facing the glass is because we have that natural daylighting that comes in. It helps calm. Anytime I’m around nature, many of us around nature, it helps us feel more relaxed. It helps us to feel calm in that space. And then also understanding what are the pieces of equipment I need to have in the space. If I design an operatory, but I’m not taking into account technology is going to come in and out of that space, I’m doing myself and my team a disservice. So what are the things that I need to do to make sure that we’re planning for, not just for today, but what’s going to be for tomorrow and what’s needed?

Bill Neumann: Yeah, well, you mentioned something that I find has that cool factor, which are the walls that move. So you can actually be in an operatory and say, OK, well, if we were going to just maybe make it a foot smaller, you can move the wall and just kind of see what that patient flow would look like, what the experience would be like for the clinicians as well. And I think that is, you know, it’s really important to actually not just have it on paper and say, oh, OK, well, if we, you know, if we shrink this and we can put another operatory in here, but actually experience, OK, what’s that going to be like for the patients and the clinician?

Michael Couch: It’s fascinating to me, and Kate, I’ll use you as an example. If Kate and I are working in tandem around a patient and we’re looking at the oral cavity, if all of a sudden that room shrinks by a foot and we’re literally right next to each other and we’re starting to bump into each other, we can see that. We can literally experience that in the space before we make an investment. That’s exactly what the purpose of a space like this is for, to reduce that cost up front.

Kate Reinert: Those mistakes that people make over and over again because they don’t have the visual. Absolutely.

Bill Neumann: You talk a little bit about Zerk’s role when it comes to organization in the operatories.

Kate Reinert: Absolutely. So our goal in treatment rooms is standardization. We want things to be as standardized as possible across all treatment rooms. It’s going to allow for more clarity when you’re in the treatment rooms. You talked about bringing technology and the same thing goes with the materials. We have excessive materials clogging up the drawers, creating confusion in the treatment rooms. That’s more brain energy that our team members have to use. So simplifying that, creating standardization, allows them to use treatment rooms for any treatment procedure. It doesn’t have to be pigeonholed to, this is our endo room or this is our oral surgery room. I see a lot of practices having treatment rooms go unused because it’s been identified as a certain procedure. And that’s just, it’s lost production. When you can bring materials where you need it instead of bringing the patient where the materials are, you’re going to have more productive opportunities in your day-to-day. And then it’s better patient care. You have more opportunity to do that in a same-day treatment scenario, where instead of rooms not available because somebody’s in there, now I can bring what I need to go into that treatment room. It also allows the clinicians to perform more confidently because they know when they walk into a certain treatment room that the masks are going to be in the same spot every single time. We hear doctors complain about that. I hate walking into a treatment room and in Sarah’s treatment room, the masks are here and I’m fumbling around because I think I’m in Katie’s treatment room and I’m looking for a mask in a different spot. It makes them appear like they’re unprepared or less confident in what they’re doing. It gives a better patient experience.

Michael Couch: Let me add on real quick, because I think one of the things that’s really fascinating and adds on to what you were talking about, Kate, is one of the best opportunities to really rethink a space is too often when you buy an existing facility or when you’re designing up front, you design it for what it is today. And that would be one of the things that I would challenge organizations to look at. What could it be for the future? And I think that ties perfectly to what you were just talking about. In many cases, we’re working with organizations, you know, group practices, you know, DSOs, and we’re looking at what can we do to actually enhance the space so it could be used for multi-specialties. So don’t just think about what it is today, but what is the way for us to maximize the efficiency and use of the space? And you might give up a little bit because it’s not as specialized as it used to be, but it allows for full utilization or better utilization of the space, which long-term is probably going to be a better outcome for the organization.

Bill Neumann: So we move from the operatory to the sterilization center. Kate, talk a little bit about instrument flow, some efficiencies that both Zurich and Midmar can create in the sterilization area.

Kate Reinert: Good, good. When we’re working with a team and we are talking about their central sterilization, the first thing we talk about is how is it going to function? Let’s talk about what are the procedures you’re going to be performing in your practice? Because with each of those procedures brings materials and instruments. How many providers are you going to have? That increases the volume. So it’s important to, instead of thinking big picture, we really have to get granular when it comes to designing the central sterilization space. Because if you don’t have room for it, it’s going to end up in the wrong place. It’s going to go missing. It’s going to go expired. And it really helps them have a bigger picture of what is the vision of their practice. We talk about that future growth, 15, 20 years. What do we need to have prepared today so that when changes do need to be made, they’re not as large in a central sterilization space. Maybe they’re just adding a treatment room. We want to create that core in central sterilization. to be as efficient as possible from the get-go. And meaning we need to make sure that we have enough space for the future growth of the practice.

Michael Couch: Yeah, absolutely.

Kate Reinert: Yeah.

Bill Neumann: Really great conversation about the sterilization center. And I never realized that it was like the most highly trafficked area in the dental practice. And you talked about bottlenecks and the issues there. Can we talk a little bit more about that? It sounds like it’s a really important area and maybe something that maybe is overlooked by some group practices and DSOs.

Michael Couch: Well, it really is. If you think about that, you have staff that are constantly going in and out of that space on a regular basis. So think about that. I’ve got staff that are going from each operatory and they’re trying to figure out what they can do to maximize their efficiency and still have time with clinicians. So, for instance, for Midmark, one of the things that we just did is we just brought out a brand new sterilization platform. But there’s three key pillars for that particular project. Durability, workflow, and compliance. And workflow in particular was one of those three key pillars. And for us, that workflow conversation was really key because we wanted to figure out what we could do. We’ve been looking at the data, and the data continues to tell us that that staff level that’s going on right now, the staff aren’t coming back and they’re not going to be coming back soon. So what can we do to simplify the work? So what can we do to reduce steps, cognitive loading, and provide better consistency for sterilization as a step? So for instance, let me give you a quick example. One of the things for most sterilizers in the industry right now is I have to step into the space to figure out how much time is left on a sterilization cycle. One of the things we did was we made sure we literally have a light bar that goes across the entire face of the device that I can see from 10 to 12 feet away, reducing the number of steps that I have to constantly take into that space. So something as simplistic as that is going to reduce steps. eight, 10 times a day per person that’s going in and out of that space. That’s huge. Little steps add up to big savings over a period of time. The other thing for us is compliance. We really wanted to figure out what are the things that we could do to reduce the steps it takes to really document what’s going on. Who’s doing the process? When are they doing it? Did they do the right steps? Is it all documented? Is there a way for us to make sure it’s consistent? Because what we were finding in the spaces that going back to the conversation we’ve been having on training and everything else is that people are not doing things consistently. So if I could put it into the user interface and make it really simplistic, like an iPhone, is that a way for make sure that it’s easy to understand, easy to learn, easy to actually do and see that consistency in the results. Makes sense. Kate.

Kate Reinert: Within socialization, we definitely want to make sure that we’re making like a one way flow. I think that that’s really important when it comes to that. Midmark’s equipment and design really supports that, and especially when we bring in our Zerk procedure tubs and our instrument setups. We have that intentional placement of these items within that one-way flow so that we are reducing bottlenecks. We know that if this is the function that’s happening here, we should be mindful of what’s the function on the opposite side of that so we don’t have too many bodies in too many places. We talked about the glass windows, being able to quickly see where things are and not having to open so many cabinets. Having the procedure tubs and the instrument setups right next to the flow shelves that have all of our materials is going to make the restocking of those that much more efficient as well. We try so hard to talk about and train team members on the efficiencies, but when it’s there and it’s intuitive, it’s going to be that much more I mean, intuitive, essentially, where they aren’t having to overthink, overstep, and making their functions that much more efficient.

Michael Couch: There’s one thing I want to add, just I think it’s a best combination of multiple solutions. So if you think about cabinetry, and you think about workflow, you think about zones. So we think about the steps, I’m going to go to step one, step two. But also what you need to do is if you’ve done a really good job, you’re actually understanding step one is going to be a specific zone. And I’m going to optimize the equipment and the items I need for that step. So I’m going to make sure that my top drawer is the things I need on every single time or 90% of the time that I’m there. That bottom shelf in the overhead cabinet, that’s going to be used, you know, 80% of the time. And then so on, what you’re going to do is you’re going to find that you can really optimize the vertical spacing in there, but also make sure it’s really clearly defined for every step along the way. It’s going to, again, help reduce steps, but also increase that compliance, that efficiency throughout the whole space.

Kate Reinert: Yeah.

Bill Neumann: There really is a science to it all. There really is.

Kate Reinert: Absolutely. Yeah.

Bill Neumann: So similar topic, but inventory management. So this is like one of the top things DSOs and group practices focus on or are interested in focusing on. I don’t know if they always do a great job at it, but they want to do a better job. So can you talk a little bit about organization, inventory management, and just some best practices and maybe what your experience is? Do you see like are most groups doing a good job or what does that look like?

Kate Reinert: Our most, you know, doing a good job, I would say it’s probably 50-50. They’re doing the best that they can with what they know. So it might not be wrong, but we know that they can do it better. And it all comes down to understanding what materials, what category do materials fall under? Is it a general disposable, meaning it’s something that’s stored in a treatment room and it’s active supply, or is it a procedure-specific material? expensive and they’re expirable. And once we understand what type of material it is, then we can really know where should it be stored within the practice and how do we manage it. Our less expensive, non-expirable items, general disposables, those go into a storage space, a little bit off-site, or not off-site, but not as centrally located. their bulkier packaging. So we want to have a wide open visual view of what they look like so that when we’re doing our reordering on a bi-monthly or monthly basis, we can go in and do a quick visual. We don’t have to spend so much time searching multiple locations for these products. And then on the procedure specific side, keeping that centrally located is ideal. Those are expensive, expirable products. And we want to make sure that when we’re in our weekly restocking cadence, which is what we recommend, they’re pulling the products that are going to expire first. First in, first out philosophy. and they’re in a central space. So when we’re doing that restocking, we’re checking those expiration dates, we’re checking volumes. And knowing that we have a week’s worth of supply in the procedure tubs allows us to be more in control of how frequently or at what volume we’re reordering our supplies. Um, and every, every practice is different. Some want to have a month’s worth of supply. Some want to have six weeks worth of supply. And that’s where we really lean into their distribution reps to help us understand what are those minimums and maximums of materials that they need to have on hand, but then training them additionally on how often are we actually checking these things, making sure that we’re doing our restocking and on that weekly cadence, it allows us to have so much more control over the volume of our inventory as well. Yeah.

Bill Neumann: I think that’s an important thing we hear a lot in the group practice in the DSO space. Everybody wants, you know, it’s price, price, price. Everybody’s focused on price. But if you’re not well organized and you have products that are expiring, you know, a lot of products like composites and bonding agents, they have like a year to two year shelf life. And if you tuck in, you know, these products are in the back, and then you reorder, and then you’re kind of putting the newer stuff in the front. So simple things like that can really, you know, save you a lot of time. And I think that makes a lot of sense.

Kate Reinert: And Bill, if I might add one other thing on that, you know, it’s I mentioned, you know, it’s not ever it’s one person’s system, right? Like they think that they know what’s best when it comes to that inventory management. But really what needs to happen is they need to create a standard operating procedure. They need to have documented process. so that when and if that person that knew the system leaves, they have something to hand it back to. Otherwise, it’s going to change again. And that standard operating procedure really needs to come from the top down, especially in group practices where you have multiple locations, multiple people in charge, different layers of management. It’s important that that standard operating procedure is set from the top down and then it’s being held accountable by the right people too. Management type team members are overseeing it so that they make sure that there’s continuity of that procedure too.

Michael Couch: Yeah, let me jump in here on a couple items, because I think it just helps reinforce what Kate’s talking about. So there’s a couple other areas for us that are really critical. So if you get the opportunity to come here, one of the things that we’re really proud of is our 20 plus year heritage with Toyota Production System. So when you go out to our factory, you’re going to see things like PAR levels. A PAR level is a concept where I understand what’s needed for the work that’s happening in that particular space, and I’m going to make sure that it’s stocked with those levels on a daily basis. On top of that, we use a concept called Now and Next. So you’ll see flow shelves, for instance, here in this facility, but you also see it in our production facilities. You see it in our medical and dental partners. Why is that really important? Because it makes sure that you’re reinforcing that first in, first out methodology. So you have a visual cue to reinforce what that needs to be. So you minimize those expiring items, those type of things. The other thing for us that’s really critical that we see in the space is making sure that storage is optimized, understanding more storage is not always better storage. Why do I say that? If I have nine foot, 10 foot ceilings, and I put tons of cabinetry in there, but it goes unused, or I’m putting backstock items in there that expire, that’s not good storage. So if I know that most of my frontline staff are going to be, you know, you know, 90% female, and they’re going to be standing during that work doing that work, having tons of extra overhead storage is not optimizing my space, it’s actually providing more problems and potential issues for the future. So, what are those things? Again, that bigger picture to understand what’s going to go on. The other thing in optimizing the space, especially going back a little bit to sterilization, but also includes in that optimizing your inventory is quick visual cues. So, you’ll see that reinforced to the floor. You’ll see that with colored glass. Even in basic storage, if you have a backstock storage, is there something you can do with glass in the front that allows for that quick visibility? I don’t have to open up something. If I can quickly see it from the outside, I understand what’s in that space and that I quickly need to understand, is it expired? Is it expiring soon? So I can make sure that I constantly have that visual confirmation of what’s in that space.

Bill Neumann: Yeah. So Kate, I’ve got a question for you. So some of the DSOs have de novos, right? So that’s relatively easy to replicate. you know, the the inventory management and the organization, because a lot of times, you know, it’s they pretty much all look the same or very, very similar designs. But what about a group practice that is acquiring practices? And again, they kind of, you know, they get what they get to to a degree. How easy is it to come in and replicate that inventory management in that organization from location to location when they’re all kind of different?

Kate Reinert: Yeah. The philosophy never changes. Our core principles never change. It’s just the location of items that change. We get really custom when it comes to those different places, those acquisitions. We can put our system in any practice. As long as the philosophy is there and the team is trained appropriately, it might look different because the physical space is different, But if we have that standard operating procedure, we’re going to create a resource manual for every practice with the philosophies being identical, but perhaps it’s, you know, this 12 o’clock is a different configuration than that 12 o’clock in a different location. While it’s ideal to have as much standardization as possible, we know that that’s not always possible, especially in those acquisition scenarios. And we want to help them just understand the philosophy behind it, those core principles, so that that doesn’t change. And then when and if they do the remodel, they are allowed to make more standardization. It still stays the same. They just update their resource guide to follow and match it.

Bill Neumann: So we move from inventory management to technology and we do a ton of podcasts on technology and a lot of AI, but there’s also clinical technologies, right? You’ve got this advent of in-office 3D printing. So that’s, you have to accommodate for those types of solutions and some other solutions that are maybe in the future that we may not even know about. But certainly in 3D printing comes to mind as something that you’re now having to maybe modify what used to be in a different office design. So talk a little bit about that, how you’re anticipating these groups bringing in newer technologies to the practices.

Michael Couch: So it kind of goes back to what are your goals as an organization that we talked about at the very beginning. For us, it’s also understanding that you need to be purposeful with your understanding that in three to five years, something’s going to change. In the next three to five years, something’s going to change. So let’s take scanning technology or imaging technology or the 3D printing technology you were talking about. Having a multi-use space that’s flexible for the future is one of those things that we’re seeing as a best practice. One of the other things we’re seeing with technology is we’re seeing the use of mobile cart technology. You’ll see workstations around here, you’ll see mobile treatment cabinets. Again, it’s talking a little bit about storage, but it’s also, what are the things that I can put in place that allow for flexibility for technology for the future? because the technology itself might update. We’re constantly seeing, you know, whether it’s our solutions or the solutions in the market that are constantly updating. So what are the things that I can do that allow for flexibility for the future, not just a fixed technology for today?

Bill Neumann: I like that. Let’s keep that term flexibility top of mind, because I think you have to be very, very flexible when it comes to these new solutions coming in. And also, again, if you’ve got your buying practices and you go back to that, I would say half the industry is probably de novo and half are acquisition based. So you have to be flexible. So the mobile cart design, do you see a lot more usage of mobile carts?

Michael Couch: So that’s one of the fastest growing areas for us on cabinetry. It’s been something that has really taken off on the medical side of our business for a number of years. And the reason for that is, what are the things, again, we’re talking about efficiency at the very beginning. What are the things that I can do to reduce steps in the clinical space? Well, what if I can bring the items that I need for certain procedures directly to the point of care instead of having this thing where I’m constantly reaching or having to step across the room? So it’s one of those things that, again, is what are those small steps that reduce? If I can save seconds per procedure, those seconds add up to minutes for the day and they add up to hours for the week. You get the general idea. So all those little things start to add up when we think about not just workflow efficiency, but technology considerations for the future.

Bill Neumann: Yeah. Michael, can you talk a little bit about the importance of sustainability in a dental practice?

Michael Couch: Yeah, sustainability, again, for me, can go a lot of different ways. So I mentioned LEED, I mentioned EDAC. Sustainability doesn’t necessarily mean you need to have a plaque on the wall. Sustainability could be as simple as the inventory management. Understand that I want to limit the amount of waste that I have in there. So having good PAR levels, having good stocking levels, making sure that we don’t have excess inventory is as much part of sustainability as anything else. But then for us, we hold sustainability to a really high level. So if we look at our cabinetry, both our synthesis products or artisan products, we made a decision almost 15 years ago to make sure that the materials we were using were going to minimize off-gassing into the space, that we’re using materials that were not only recycled but recyclable in the future. But they’re durable, they’re built for the clinical environment. So all of those aspects are part of sustainability. So sustainability isn’t just this nuanced singular approach, it’s this overarching design. Are there things that I can do to have more natural daylighting to reduce my energy usage in the space? Are there things that I can do to have more efficient use of water in the space? All of those things are a part of sustainability and are all approaches that we look at when we look at our designs that we work with, with our clinicians with.

Kate Reinert: And I look at sustainability, too, from the perspective of our team members. They need to be able to perform at their highest level. And we’re in clinical settings. We have to make really quick decisions. And we can’t have those inefficiencies bogging down those quick, critical decisions. When we have a patient in the mouth, we’re mid-rook now, and we’re trying to decide, is this going to go surgical extraction or can we save this tooth? We need to be able to save. as much of their energy as possible, and that sustainability carries over to them too.

Bill Neumann: Absolutely. Planning versus reacting. Kate, as a clinical efficiency consultant, how do you take, which I think it’s human nature to be reactive, so how do you kind of change that mindset?

Kate Reinert: You know, we just want to have team members, practice owners, you know, whoever the decision maker is, make as informed decisions as possible so that they aren’t making mistakes in the future. We see it over and over again where we’re trying to help a team in the space that they’ve created, and it’s really created an efficient workflow. Identifying, again, the vision of what their practice is going to be. Having that, you know, they’re in the mindset of, I need to open the doors on August 1st, and we’re in the mindset of, we need to create that growth. for 5, 10, 15 years down the road. And when we are reacting to a plan that they’ve already set in stone, that’s where dollars are going out the window because those inefficiencies that occur, the wasted materials, not having the opportunity to grow within the space as well. So if we break it down, bring them back to reality and say, You’re not building for August 1st. You’re building for 15 years down the road. What does that picture look like? How are we going to create the space to be as efficient as possible, to be as productive as possible, and still give your patients and team members a really good experience? We want to be able to have them have that foresight when they’re doing that planning process.

Bill Neumann: And I think this topic’s really important and a couple of the things that we talked about before, whether it’s bringing that new technology into the practices. I mean, you look at this from a recruitment and retention perspective too, which we really didn’t talk about, but it’s one of the biggest challenges still. We thought it was like a COVID thing and then it just continues on and on and on. And I think you shared some stats with me last night about hygienists and the lack of hygienists. But I think it’s, so how do you keep your employees, right, your clinicians, your office staff happy? And I think younger doctors and hygienists and assistants are looking to work for a practice that has technological solutions, that has a pleasant operatory design. You talked about like the natural light and all these things that, you know, I don’t know how much thought goes into that from the DSO side of things sometimes. They’re looking, of course, a lot of times at cost. But boy, it’s really expensive to hire and retrain. And sometimes it’s next to impossible to find people now. So maybe talk a little bit about that and what you kind of experience with maybe satisfaction working in an environment that’s organized and has new technology and newer operatories.

Kate Reinert: I can speak for myself as a clinician. Culture is huge, especially now. You talked about those newer doctors coming in and wanting to have a place that’s comfortable to work both in a physical space but also in the culture. And I think part of that comes down to having those set standard operating procedures. There’s no confusion day to day or when there is that staff turnover as far as who’s gonna be in charge of this now. Walking into a space and focusing on the clinical care is what team members want. They don’t want to have to be rethinking or reinventing the wheel every time that a new process comes about. So I think being able to have systems in place is attractive to team members so that when they’re bringing in, when they’re coming in, they don’t have to focus on how am I going to learn this or what is my onboarding process going to look like because they have those SOPs in place and they’re ready to give them that onboarding experience and give them the opportunity to focus on what matters most and that’s patient care and then the healthy working culture that they have as well.

Michael Couch: Yeah, just to expand on that. So there’s a couple items. That patient outcome, it should be at the forefront for all of us, whether us as manufacturers, as we design new solutions for the future, but also for the practices. And we see that and hear that constantly when we work with different groups. But at the end of the day, we really need to make sure that we are not thinking about just those first costs. I’ve talked about it multiple times, but that future flexibility. So what does that mean? I need to really think about early design upfront. for that staff to make sure we avoid cost of rework, we avoid the turnovers that you were talking about. So the stats we were talking about last night, HPI had some information they had published not too long ago, and they were talking about hygienists, dental assistants. And the fascinating thing was even post-COVID, we’re still looking at the pool that is out there right now, we’re only at roughly 63%. of what we should have for dental hygienists. And for dental assistants, it’s roughly 70%. So we are well short of what we really need to have optimal usage or utilization of our dental spaces. So again, that just reinforces what I talk about for the future. So as we think about technology, we think about retaining those dentists, we think about retaining the staff. It’s incumbent on all of us to make sure the design is thinking about what can we do to reduce that cognitive load, those steps, to help them be more efficient and really focus on the outcomes for the patient, the patient experience. Because ultimately at the end of the day, that’s why we’re here.

Bill Neumann: Right.

Michael Couch: We’re not, I’m not here to sell product. I’m here to have a better outcome for the patient.

Bill Neumann: Yeah. Last couple of questions for you. It’s been a great conversation. Michael, you mentioned you don’t have a crystal ball. So I’m not going to ask you to pick out your crystal ball because you don’t have one, but maybe if you could just give us a little insight as to what you see the future of practice design. We talked a little bit about technology and how that’s going to impact things, but maybe some other thoughts on that. And Kate, I’d love your feedback.

Michael Couch: Yeah. There’s a few different areas that I see that are really impacting dentistry for the future. Number one, this may or may not be something that’s on everybody’s radar, but you have a rapidly growing geriatric population of 65 or older, and that’s going to continue to grow for the next 15 to 20 years. those are going to be potentially the majority of your patients. Patients are keeping their teeth longer, they have healthier teeth, they have more disposable income, and they’re going to spend more in that space. So are you thinking about what that practice and that operatory space should look like for the future as you think about what you’re doing in your design? So whether that’s an existing facility or a de novo facility, that should be something that we’re thinking about for the future. The other thing for me is just understanding those stats that I was looking at. What are the things that we can do to really look at the future generation of clinicians that are coming into the space? So can I make sure that I built technology into the space that’s gonna allow for me to easily update the solutions? So for instance, if I look at an operatory, if I start off with just air-driven hand pieces, Can I quickly and easily upgrade to electrics when and if I need to? And do I have I taken into account what that workflow might change for things like sterilization for the future? So to me, those are major things. And the third the third thing for us in particular, and you see us talk a lot about medical dental integration, But I personally believe that that is going to continue to be a major factor for the future. We’re seeing more and more organizations, you know, DSOs providing medical care. We’re seeing health systems providing dental care. We’re seeing insurers provide dental care as part of their plans. That conversation, allowing patients to basically access care and see it looked at in a more broad continuum. So allowing you to not have to put in all the drugs you take or whatever else, maybe you don’t take a bunch, but if I look at pharmaceuticals and stuff like that, so I don’t have to fill that out in 20 different places. The fact that I can carry all that information and look at that as a continual healthcare journey to me is gonna be a bigger conversation for the future.

Kate Reinert: When I look at the future of dentistry, I look at the, you just mentioned it, the staff shortages that they’re experiencing. Teams are going to be more lean. They’re going to have to have more systems in place, more refined processes to operate on more lean skeleton crew, essentially. You know, if we don’t have the schools to support, we don’t have the people that want to go into the industry, we’re going to have to find a way to make ourselves more productive on less people, do more with less, like you were saying before. So I think the team perspective is something that’s going to change. We’re going to have smaller teams and even bigger organizations, bigger footprints. And as long as we have those systems in place, it should operate just fine.

Bill Neumann: Agreed. Well, thank you both. Wonderful conversation. Thank you, Kate and Michael. And thank you, everybody, for watching this today. The Experience Center. If you want to actually come out and explore the Experience Center, you can go to midmark.com forward slash experience. There’ll be a form there you can fill out. And you also have an event coming up in November. It happens a couple of times a year called Impact Design. Can you talk a little bit about that?

Michael Couch: Yeah, and Zerk is going to be involved with that as well. But really, it goes back to some of the conversations we’ve had this morning. It’s really about having an opportunity to come, bring your initial thoughts and ideas for what you want your practice to be for the future, and then really get challenged about what it could be, how it could be efficient for the future, and how you can plan for those additional variables that we were discussing. So that is a multi-day event. It allows you to think about everything from finance to planning to architectural considerations to workflow efficiencies, all your staff, everything else. So it’s an excellent event. Please look at it. We’re really excited to have you here. We’re going to have it here in this space. So again, really get to experience the Experience Center, but really help reinforce best practices.

Bill Neumann: And that’s great. And you can find out more about impact design and go to midmark.com forward slash impact design. And the events in November, we’ll put the dates in the show notes. So you’ll see when that is. But that’ll be a great way to actually explore the Experience Center and then learn a lot, too, at Impact Design. And Kate will be there. So there’ll be a focus on organization as well. So Kate, if anybody wants to find out more, contact you, learn a little bit more about ZURC organization, how do they do so?

Kate Reinert: They can go to right to our website zerk.com. The best place to start is with a discovery call. We need to learn what is your vision? Where are you at in your practice right now? Are you an existing practice that is just looking to reorganize? Have you identified that your inventory spend is higher than it should be? The best place to start is learning for us to learn from each other. So you’ll want to go to zerk.com and then book a call, book a demo. That’s the best place to start.

Bill Neumann: Well, thank you everybody again for watching this today. Until next time, I’m Bill Neumann, and this is the Group Dentistry Now Show.