Improving a Dental School's Clinic Operations Using Lean Process Improvement

Abstract

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-valueadded components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-outthe-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Lean Methods Applied to CAD/CAM Pedagogy in the Dental Simulation Laboratory

“…‐ 16 Process improvement principles have long been used in business environments to improve efficiency and enhance quality 17 , 18 . They are now being implemented in public services, dental education, and the delivery of oral health care 15 , 16 , 19 . While lean management is becoming a trend of research in the health care arena, recent reviews of the health care literature from 2000 to 2015 found that only 45‐51% of the studies used lean techniques to enhance operational performance 19…”

Improving Dental School Clinic Operations Using Business Intelligence Data

“…A study at the University of Kentucky School of Dentistry evaluated patient satisfaction when appointment length in the emergency clinic was reduced from four hours to three hours using Lean processes 1 . Reducing the length of the appointment may also enable care to be delivered to more patients; however, that factor was not measured or reported in that study.…”

“…This difference may mean that improving efficiency could have very different meanings and pathways at different dental schools. There is very little research on efficiency in dental school clinics other than the Kentucky and Harvard studies 1, 2 . When the scope is broadened to consider process automation in dentistry, one study focused on laboratory processes (rather than clinical processes) found that error rates and patient safety improved 6 .…”

Lean Product Development and Publish Ahead of Print

“…In 2007, Teresko noted that Toyota's innovation was driven by the company's “commitment to ‘the importance of appropriately integrating people, processes, tools, and technology to add value to the customer and society,’” in the words of the authors of a book on TPS 1 . At that time, Teresko emphasized that successful companies had learned that “less of [their] edge now comes from TPS and more comes from adopting lean product development practice” in combination with “dedication to continuous improvement.” In dental education, academic dental institutions have used these processes to improve management of the dental clinic and to streamline overall dental school operations 2 , 3 . Introduction of lean product development in all these areas has been greatly facilitated by innovations of the digital age.…”