Improving a Dental School's Clinic Operations Using Lean Process Improvement.
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-value-added 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-out-the-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.
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky. robinson.1490@osu.edu.
Fonda G
FG
Robinson
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
Larry L
LL
Cunningham
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
Sharon P
SP
Turner
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
John
J
Lindroth
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
Deborah
D
Ray
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
Talib
T
Khan
Dr. Robinson is Associate Dean of Clinic Administration and Patient Care and Associate Professor, Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University; she was Associate Dean of Clinical Affairs, College of Dentistry, University of Kentucky at the time of this study; Dr. Cunningham is Interim Chair of Oral Health Science, Division Chief of Oral and Maxillofacial Surgery, and Professor, Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky; Dr. Turner is Dean Emeritus and Professor, Division of Public Health Dentistry, College of Dentistry, University of Kentucky; Dr. Lindroth is Associate Professor, Division of Oral Diagnosis/Oral Medicine/Oral Radiology and Director of Urgent Care, College of Dentistry, University of Kentucky; Dr. Ray is Assistant Professor, Division of Comprehensive Care, College of Dentistry, University of Kentucky; Dr. Khan is System Director, Performance Improvement, St. Vincent's Healthcare, Jacksonville; and Ms. Yates is Lean Facilitator, UK HealthCare Center on Enterprise Quality and Safety, University of Kentucky.
Audrey
A
Yates
D003740:Dental Clinics / Q000458:organization & administration* / Q000592:standards; D017598:Efficiency, Organizational; D011787:Quality of Health Care; D012575:Schools, Dental; D017749:Total Quality Management
clinic management; continuous improvement; dental clinic; dental education; lean production; patient care management; patient satisfaction; practice management