Posted by: Knightbird | July 29, 2010

The Customer Comes First

I just received a reimbursement check from a major Alaska Native health system provider last week. In 2005, I needed at least 1 root canal due to a significant infection that developed while I was traveling. I booked an appointment (and was told that if I came in early the next morning I could probably get in that day because of significant numbers of no shows, and I know why they have lots of no shows). So I went in and waited for hours. When I was brought into the exam room, I was X-rayed, examined and told that I had a significant infection, and that I needed a root canal. Then I was told that the wait was about 8 weeks, and before they would book an appointment for me, I had to pay $350 down. Then I was told that I had to have my teeth cleaned before they would even consider booking me for the root canal, and that wait was pretty substantial as well, but if I did the early morning check in and someone didn’t show for their cleaning, I could take their place–first come first served. I paid my $350 wondering how I was going to comply with all of their demands with a raging infection and lots of pain. The real shocker was when they let me go without any antibiotics for controlling the infection. As an attorney, I was shocked at this treatment. I consider it malpractice.

After walking away shocked, I went back to my office and called our dentist in Seward. She told me to come on down, that she was qualified to do root canals, and by the end of the week, I had my root canal.

This was about the time I was learning about lean health care, and I began to realize what happened at this particular tribally run health clinic. Their focus was clearly set by an executive, and required maximization of revenue. And when I presented with insurance, they realized that I held revenue potential and their goal was to grab it. I felt that their total focus was on the deposit. I was told about the deposit requirement by every employee I came into contact with. And since my insurance paid for the cleaning, they made that a requirement so they could secure that payment as well. And their processes had to be extremely bad because the wait times were horrendous. Who can wait 2 months for a root canal when the tooth is infected and generating considerable pain.

I said earlier in this post that I know why they have lots of no shows. It’s because of the extremely long wait times. If you cannot do todays work today, people tend to find a place where the work they need can be done today. That’s what I did, and I was so relieved that I didn’t even think about the $350 I had paid to this provider for the root canal. And because of how poorly run they are, I am not surprised that 5 years later, I received the reimbursement check in the mail.

When the customer comes first, employees are free to do whatever it takes to make sure their needs are taken care of. That’s why I use a private dentist instead of the local tribally operated dental clinic.


  1. Wow! What an experience you had! You probably already thought of this, but I wonder if the local dentist and/or their management might consider reading Sami Bahri’s Follow the Learner, about how one dentist turned his practice around using Lean. Sami is the “World’s First Lean Dentist.” At just 85 pages it’s a quick at meaty read.

    A few months ago I had an appointment at a clinic and as I waited and waited, eventually in the exam room, I heard my doctor sigh from just outside the door, “It’s 11:00 and this is my 10:00 appointment.” Knowing it bothered him, too, I told him about my role as a Lean Coach and about this book and he ordered it. Sometimes planting a seed can result in a lot of grain…

  2. I sure wish it were that easy, Mark. I wrote a letter about Lean to the CEO in 2006 and had a meeting shortly after. Nothing. But thank’s for the info about Dr. Bahri’s book. We have a Dentist and I plan to order it for our use.

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