The pandemic abruptly changed the way we deliver patient care. Health-care professionals across the country implemented enhanced engineering and work practice controls, along with additional personal protective equipment (PPE). Since that time, what changes have you kept and what changes have you dropped?
Some changes implemented during the peak of the pandemic forced offices to operate more efficiently under constraints, such as reduced staffing. In most dental practices, patients spent less time waiting in the reception room and were able to check out effortlessly using text-to-pay options. While these workflow changes were implemented in response to a crisis, they aligned with concepts of the lean theory.
You may be wondering, what is the lean theory? According to the Lean Enterprise Institute, “Lean is a way of thinking about creating needed value with fewer resources and less waste.”1 Now you may be wondering, what is needed value and what purpose does it serve? How can we continue to do more with less? (“I need more staff!”)
You might also want to read: Your new best friend for infection control: GreenLight Dental Compliance Center by Hu-Friedy
What is lean and how does it work?
It’s helpful to think of lean as a method for enhancing quality, such as in-patient care or job satisfaction, as well as value, something appreciated or desired. This is accomplished by using only the necessary resources and eliminating waste. The Agency for Healthcare Research and Quality (AHRQ) defines waste as “any activity that consumes resources without enhancing value to those being served by the process.”2
Think of waste as unnecessary steps as well as all the unnecessary resources used during a process. For example, consider the last time you took in your car for an oil change. Did you have a long wait? Was the paperwork easy or cumbersome? Did it take a long time for the service to be performed? Ultimately, did you leave satisfied with the quality of the work and did you feel valued as a customer, or did you feel your time was wasted due to many inefficiencies? This illustrates how the lean methodology works.
Through the years, lean methodology has also been applied to health care to improve the quality of patient care. When applied to health care, it’s often called “lean health care,” and it embraces a culture of continuous improvement. Continuous improvement is a team mindset that encourages everyone to continually ask questions, such as “How are we doing?” or “Can we do it better?” Think of better as enhanced efficiency, effectiveness, or timeliness; for instance, how can we improve scheduling or streamline filing insurance claims?
Research reveals that many lean health-care projects seek to improve efficiency and quality at the departmental level, for example, increasing the number of lab specimens processed per hour, reducing nursing medication errors, or improving patient satisfaction scores. The outcomes of these projects result in timelier diagnoses when lab specimens are processed more efficiently, and patient safety is improved by reducing medication errors. Ultimately, lean health-care projects lead to improved patient satisfaction and improved delivery of care. As you can see, lean concepts focus on improving processes, not reducing staffing.
We’ve all heard the saying, “If it ain’t broke, don’t fix it.” Think of a process or workflow in your office, such as instrument sterilization. Suppose there haven’t been any safety issues or complaints from team members or patients. In other words, no team members have been cut or poked with a contaminated instrument, and no patients have complained that instruments “look dirty.” That doesn’t necessarily mean there are no opportunities for improvement. Poor workflow design, cramped spaces, and insufficient equipment to adequately handle the volume of instruments to be sterilized are signs of an inefficient process.
This brings me to the question: how do you know if something is “broke” or if it can be improved if you haven’t evaluated it?
Lean theory and compliance documentation
Let’s take this a step further: what if we applied the lean theory to the way you manage compliance documentation? If keeping up with patient care leaves little time to manage regulatory compliance documentation, perhaps something is broken.
Have you been in a situation where the team member responsible for key compliance tasks quits, and no one knows where to find the documentation or how do you respond when a regulatory auditor shows up? What about your new safety coordinator who can’t make heads or tails of the previous safety coordinator’s documentation, so decides to create their own system? Either scenario is a lose-lose situation. All involve wasted time and additional paperwork, and detract from quality patient care.
Instead, let’s turn those scenarios into win-wins by identifying what having lean documentation means. As with patient care, applying lean involves having a continuous improvement mindset. That requires having a culture where it’s safe, and even expected, to continually ask questions, such as “How are we doing” or “Can we do it better?”
This involves having an open mind about revising any process—from patient check-in to compliance. In this example, it’s the process for creating and maintaining digital compliance documentation. Digital compliance versus paper binders minimizes waste, particularly wasted time to compile and organize critical compliance documents that can get lost or misfiled. You will have exactly the information you need when it’s needed.
Sterilization monitoring is a good example. Suppose you’re conducting weekly biological monitoring as recommended by the CDC and required by state dental practice acts. Who in your office is notified of the results? Are they called or emailed if there’s a failed test? Who is responsible for troubleshooting failed tests? How is the documentation stored? How long are the test results kept? Is your paper binder overflowing with weekly test results? Is it hit or miss as to whether the results are even viewed, much less printed out or acted upon?
Take a minute to reflect on the sterilization monitoring process in your office. Do you identify with any of the questions here? Is it possible that your process is not as effective and consistent as you’d like? As they are now, there may be room for wasted resources and incomplete documentation. Lack of defensible documentation creates a risk exposure for your practice.
There is a better way!
Technology abounds in dentistry. On a daily basis, dental practices and organizations text appointment reminders, acquire new patients through online scheduling portals, and host their patient records in a cloud. Not to mention digital imaging, crowns in a day, and artificial intelligence. So why not leverage technology to maintain digital compliance documentation as well?
Circling back to the definitions of lean and waste, think about how digital compliance documentation could create needed value with fewer resources and less waste. What would the needed value look like? For starters, there’s value in knowing you have the required regulatory documentation and that it protects patients, staff, and the practice. Maintaining the required documentation digitally illustrates that a particular task or requirement was performed and eliminates the loss of paper documents.
What waste would be eliminated? If your safety coordinator is in charge of all the compliance documentation, is there a succession plan if that person leaves? Will anyone else know where the documentation is kept, and is it easy to follow? Is all the required documentation up to date? Would the successor safety coordinator have to start from scratch? Recreating regulatory documentation wastes time and resources, not to mention potential regulatory violations.
What if there were a digital compliance system that enhanced efficiency, effectiveness, and timeliness of regulatory and safety documentation? HuFriedyGroup’s GreenLight Dental Compliance Center keeps key regulatory documentation, along with all your infection prevention guidelines and regulations, conveniently housed in one portal. Maintaining compliance doesn’t have to be a burden. GreenLight offers a great deal of value without the waste.
GreenLight’s key features
- A one-stop resource for updated compliance information.
- Customized infection prevention protocol templates compliant to your practice’s specific requirements (including CDC, federal OSHA, and state dental board guidelines and regulations).
- A portal to maintain key compliance documentation, such as the results of monitoring dental unit waterlines and sterilization.
- Training and resources specifically for infection control coordinators.
- Easy access to state board web pages.
Another important benefit is the impact of implementing lean concepts throughout your organization. Creating consistency yields big results in the areas of brand trust and reputation as well as measurability and tracking of process improvement.
Teresa Spence, practice administrator for Amelia Dental Group in Fernandina Beach, Florida, said their practice is unique in that it has two separate state-of-the-art instrument reprocessing centers that are well-equipped to manage their busy workflow. They use the GreenLight Dental Compliance Center to manage infection control protocols and quality monitoring test results.
She explains that they have seen demonstrable improvement in office workflow. The efficiency, consistency, and productivity related to instrument flow and storage have had a positive impact on morale and teamwork. “Our team is now empowered with a good workflow so each team member can be their best for one another and their patients,” Teresa states. That, coupled with the fact all the required compliance documentation is housed in one location, has resulted in more quality time to spend with patients.
If you’re ready to enhance the value of your compliance program to benefit your patients, team, and practice, think lean. Think GreenLight Dental Compliance Center!
Editor's note: This article appeared in the September 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
- What is lean? Lean. https://www.lean.org/explore-lean/what-is-lean/
- Reducing waste and inefficiency in health care through lean process redesign: literature review. AHQR. Published September 2012. Reviewed May 2018. https://www.ahrq.gov/research/findings/final-reports/leanprocess/leanprocess.html