Applying Lean Methodologies in Private Dental Practice - Report Example

Running Head: Lean Methodologies in Private Dental Practice Applying Lean Methodologies in Private Dental Practice s ] Abstract The application of lean methodology can lead to many benefits in the healthcare sector. Lean methodology is essentially of getting more out of less, but the main focus of attention is the consumer itself, and ways to ensure that the customer is given what he or she needs in any area of the society. In the past, the organizations failed to focus of strategies that could help improve performance, and not just rely on inspection methods. Lean methodology aims to improve production at all levels of provision. The potential of this methodology in dentistry is yet to be explored but the initial studies and results have shown massive potential in this regard. Understanding the key areas where lean methods can be employed will help the dentists decide on how to take up lean methods for their own setups and increase their overall level of performance? Applying Lean Methodologies in Private Dental Clinic Settings Lean thinking is a concept that is quite recent in healthcare sectors. It is even more so when it comes to application in the dentistry and dental clinics. Lean thinking in the recent times has shown remarkable promise in small businesses and large, and therefore, its application in the quasi business settings of a private dental clinic can also be explored to maximum benefit. The concept of lean thinking in healthcare industry has generated much interest around the world. It is not surprising therefore, to see literature pertaining to it among the governments planning as well. The UK is now one of the avid followers of lean thinking management, and is devoting much research in to understanding the fundamental concepts of the model and methods of its application into the healthcare system. Perhaps it is an attempt to find a better alternate solution to the already mounting problems of the healthcare in the UK (as well as around the world) where managed care system is rapidly revealing cracks and flaws in its structure and planning. Till then, lean thinking may be able to provide support to this rapidly aging system of healthcare. Dentistry like other areas of healthcare is also hard hit by the different problems that are plaguing NHS, and therefore dental structures can also be utilized to study the potential benefits of lean methods within healthcare. The accusations of inadequate healthcare service within the UK are not without proof. In 2005 alone, the loss reported by NHS amounted to astounding ₤ 500 million. (McAllistor,2007) this is in spite of increased costs and efforts being placed in healthcare to address the situation of increased healthcare burden, decreasing staff and funding issues. NHS is under threat to lose even more in the future years unless steps are taken that address the issues of today. With continuous threats to the loss of production of many hospitals in the future, the NHS is willing to try any new approach that may help solve or at least reduce the crises. Therefore, among the many new approaches, lean methodology ranks as one of the new ones to correct the current healthcare crises. Concept Of Lean Methodology The concept of lean thinking originated in Toyota, where the aim was to focus on the value stream of the product and the product itself. It is not surprising therefore to state that Toyota and lean methodology have become synonymous, and therefore the leaders of lean management and thinking.(Womack et al, 2005) This concept is completely opposite to the concepts of organization that are currently applied in the consumer market and in businesses around the world. Managers must, according to Toyota, focus of the process of production rather waste time on inspection, which will yield better and improved results long term, and will lead to more effective savings in terms of money and resources. (Womack et al, 2005) This is perhaps the first methodology that focuses and emphasizes on the respect for the society and its people, and treating them so, rather than just heads. (Jones, 2006) The concept is therefore focusing on the client and the quality, and not on mass production. The focus in this methodology shifts to the waste management, where the identification of excess waste becomes the focus, and strategies are made to reduce the wastage of resources. By enhancing the value of the product and the service and by proper management of the waste, the result can be a highly efficient organization and better management of the resources at hand.(HIBCC AU, 2005) The core concept therefore becomes the identification of waste in any sector, removal of wastage, and increasing value by increasing attention towards the consumer. The consumer therefore becomes the primary focus in this regard, and defines and drives the organization’s plans, setups and ultimately the product.(Womack et al, 2005) As always the Japanese method of defining lean methodology is inanely profound, simple, and concise; “using less to do more.” (Womack et al, 2005) The concept at first was very foreign in many of the organizations and its universal applicability uncertain. However, now the benefits of employing this methodology is fast becoming akin to a trend in the industrial, managerial, and even the healthcare sector. Lean methodology is among the most popular methodologies in Japan and is avidly used in the many sectors touching consumer lives. Therefore, it is perhaps the most fertile ground to study and learn the various aspects of lean thinking. Through research studies, it is now evident that application of lean principals helps in “increasing the productivity, cost, quality, and timely delivery of services.”(Womack et al, 2005) Japan now conducts the most up to date researches and informatics for lean methodologies. Contrary to the assumption one might perceive, lean thinking is not about reducing costs to make an organization efficient. Rather, it is a method that is aimed towards improving the overall individual units of any organization, which in turn would lead to improvement in the quality and productivity as a whole. Therefore, the issue is not about the cost, though it does play a major role in it, but rather the proper utilization and application of all that goes in to a particular organization, and in this way managing the waste which comes into description frequently. Identification of methods that improve various steps in any process will help in terms of productivity, costs and will in turn lead to cost management as a result. The process of lean thinking therefore, becomes very simple. It becomes the identification of factors that lead to enhanced performance and results, and removal of all that lead to wasting of resources, time and money. (Womack et al, 2005) The reliance on the inspection for the identification of flaws is not considered an option. It is just considered to be an aid to an already established and organized manner of performance. Many factors are critical for the success of lean methodology. These include “organizational culture and ownership, developing organizational readiness, management commitment and capability, prevention of under resourcing, provision of external support, communications and engagement, strategic approach, teamwork and proper timing of implementation.” (Scottish Executive Research, 2007) These critical factors must be identified and adjusted accordingly before the commencement of lean methods, as the results are very much affected by them. Implementation of Lean, the Tools The beauty of lean is that it can be applied to any organization with minimum of changes. The progress is generally carried out in six phases, where the first phase constitutes the project launch. This first phase mainly decides on the plan through which the whole lean management will take place and what will be carried out in this regard. The second phase is site assessment and operations plan, followed by the phase solution design and prototype, complete integration design, integration testing and finally training, go live support respectively. The similar plan is carried out in healthcare, where these same phases become individualized according to the nature and type of the department under consideration. This is because not all principals are applicable in all areas of healthcare simultaneously, and lean methods focus on individualizing the issues of each compartment in order to work effectively. Six Sigma and Lean Methodology Six sigma methodologies has now become an integral part of the lean methodology. Previously made to tackle issues of manufacturing defects, the six sigma principal has evolved to include other areas of businesses and enterprises. Six sigma follows the rule of DMAIC, a scheme that is essential in the different processes of evaluation and planning. This includes Defining the problem, Measure of inputs and outputs, Analyzing the process, Improving the process, and continuing Control by monitoring. The tools included in the system also include value stream mapping, work management methods, 5S and cell layout. (Six Sigma Systems, 2007) Together with lean methods, six sigma promises a good return and positive and even drastic improvements in any area where they are applied. Six sigma therefore, becomes a very valuable candidate for the healthcare industry. The application of its principals is very easy, and can be managed according to the individual variations. Even more intriguing for the healthcare industry is the Kaizan system based on its meaning of constant improvement. Kaizan system however, has not yet found its roots in this healthcare and it will take some time before its true benefits can be demonstrated. The system yet still promises a very bright prospect for healthcare. Its application can include many areas of health care sector and includes admittance, processing of medical information and records, catering to patients’ financial services, pre registrations and clinical areas among the few. (Six Sigma Systems, 2007) Examples of Success of Implementing Lean There are many examples of successful implementation of lean methods in to many organizations, and the resulting increase in productivity. The first and the foremost is Toyota itself, which is now a world acclaimed brand and relied for its perfectionist attitude towards customer service delivery. Eastern Aero Machine, Custom Windows, Edwards Manufacturing, Winslow Life Raft Co., Pelican Wire Company, Hanger Prosthetics and Orthotics etc. are only a handful of successful enterprises that are reaping great rewards after implementation of lean methods. The list continues to increase both in UK and globally as more and more industries begin to see the effects of improved performance in the outcomes of businesses. The US is another location where the benefits of lean methodology are being implemented in the healthcare system. The Healthcare Excellence Institute in Kansas is currently one of the most active places where models and experiments are carried out to test the efficacy of the lean methods. So far the results are very positive. For example, the researchers here claim that bed management, an important issue in hospital management, has seen considerable improvement. The bed turn around time has dropped 30% after the implication of the lean principals and six sigma principals at the institute, increasing productivity to remarkable levels. (HEI, 2007) The same institute was also able to demonstrate a reduction of HIM processing time from 10+ days to less than 24 hours. The medical logs are now processed on the day of receipt with the elimination of backlog. This in turn reduced the floor requirements by 30%, and productivity was increased by 50%. The application of lean therefore in the healthcare sector is a definite possibility. (HEI, 2007) Lean Thinking in the Health Care Sector The application of lean thinking in the healthcare sector promises many outcomes than previously anticipated. While initially, the researchers were skeptical about the outcomes of lean methodology in the healthcare sector, now more people believe that reverting to this system can actually lead to saving of the NHS and other related healthcare industries. This is the beauty of lean methods, which it is applicable in virtually any environment one may choose to. And the results are many fold. The aims are so flexible that they can be easily applied to any system, and then modified to provide the best possible results. It is not surprising therefore, that the healthcare sector and NHS UK are reviewing this system’s application in to their own sector. (Jones, 2006) The focus therefore becomes that lean becomes not only an aim, but also part of the organization’s proceedings. This also means that people, that are the doctors and the paramedical staff, also are included in the endeavor. By including the parts and components that drive the organization, there is more motivation and effort and therefore, greater yield of the results. It is this reason also, that means that lean application is from within the organization and not externally applied, and in which case identification of specific issues may be lost to generalizations. The current problems faced by NHS are many and include financial deficits, increased and unnecessary deaths, constraints both in performance and in capacities leading to inefficiency, and the general concerns that are a result of such problems in the public, along with the high costs and poor results. While pundits may argue that these problems are not unique to the healthcare industry alone, it does not exempt healthcare providers from the responsibility they are entrusted to do. And therefore, application of lean may be the lifeline that NHS was looking for.(Jones, 2006) The effects of lean so far, as claimed by NHS are amazing. Lean has been seen to improve results and outcomes through provision of quality and safety, and improvement in the methods of delivery. Other results include improve throughput and accelerated momentum. But perhaps the biggest reason why these changes are so unique and perceptible is the fact that lean includes the staff, whose enthusiasm is the main cause of such accelerated momentum. (jones, 2006) The lean system corrects the many flaws of the healthcare system, which previous systems were unable to do so. Correct allocation of responsibilities and resources, with more efficacies is the key finding of any research that has been carried out to support the lean methodology. Lean principals can therefore help reduce “internal and external costs, improve patient safety, increase profits, reduce litigations and decrease dependence on Government and Insurance.” (Correa et al, 2005) One of the main applications in lean is the term Lean Manufacturing. This system enables the organization to strive and prevent waste, and therefore devise strategies in this area, remove any inconsistencies or problems, and promote a culture of perfection in the workplace. This application of principal therefore starts at the bottom of the work chain and continues upward to the top, thus enabling proper application of systems. The application of this principal becomes “IDEAL” in healthcare, where aim is to provide the consumer that is the customer with the service that he or she expects. Modern healthcare is now a customized kind of service and therefore a good hospital is one that is able to deliver exactly that to its patients. Alongside, prompt delivery of healthcare services as per needed by the patient. The ideal hospital service therefore, must be made that is in every way protective for the patient and providing a safe and trusting environment to him or her. (Correa et al, 2005) Application of lean however, requires many steps for it to start performing. The first and foremost step is for the leaders to identify that they need lean methodology in their healthcare settings. Recognition of this need will help leaders in setting goals for the team and implement proper strategies. This may mean complete change of the business settings than were carried out before. This cannot be possible until proper knowledge and education is provided to the leadership front. Understanding the fundamental concepts of lean is essential for a successful enterprise. Since lean is intimately related with the future of any company that it is taken up in, it is important to design a strategy and plan as to how lean will be applied to the system under observation. The inclusion of all levels of organization is the next basic step to get results. The anticipated results in healthcare sector are already expected to be very high. The overall turnover time for critical care can be dramatically reduced, as demonstrated through some hospital examples discussed below. This is not the only area that may benefit, the medical recording, pharamacy and registration areas of the hospital management can also improve dramatically. Challenges of Applying Lean It is important to understand that lean is still a difficult process to instill, despite the simple exterior. The proper motivation and devotion is essential, and so is the need to address wastage at highest priority. Leadership as stated above is the main factor that will lead to ultimate success or failure of the enterprise and therefore proper education is important in this regard. Mistakes are a part of lean, but the more important factor is the foresight to address any mistake that is underway. Last but not least, the process of lean means never to be satisfied with the progress, and continued effort to improve the organization. Therefore, lean continues to take place in any organization that it is implemented. (Healthcare Management, 2007) Many factors have been identified as barriers to successful lean methods application. These include “people, lack of ownership, identity of improvement team members, failure of leadership, compartmentalization, lack of linkage between improvement programs and strategy, lack of resources, and poor communication.”(Scottish Executive Research, 2007) Application of Lean in Private Dentistry The benefits of lean methods in healthcare sector extend to the many dimensions of the system. And it is therefore of no surprise that its application in dentistry is also under review. Dentistry is perhaps one of the main healthcare sectors that face extreme wastage in terms of time and management. Dentistry is one of the most expensive healthcare provision services, which is under constant scrutiny. The costs in running a dental clinic are higher than average of any other healthcare providing places. The effects of cost therefore becomes of more concern than any where else. The necessity of adherence to quality both in terms of service provision and instruments and materials is more important than ever. Six sigma and lean can therefore be a very helpful means to manage the issues of cost versus customer satisfaction. Dentistry and dental schools run at very different pace than their other healthcare counterparts. The management concepts therefore are very different even at the basic levels. The students and young dentists are made to face two completely different work environments of private and university dentistry. The need to confirm often drives these dentists to opt for the methods that they had employed during their degree years. These management concepts of dental schools invariably find their way into the private clinics, which in turn lead to loss of productivity in the private sector as well. This is because of the fundamental differences in the running of these two completely different institutes, for which the new dentist is completely unprepared. The dentists learn to compartmentalize their work and work in sections of specialized fields. In doing so, they arrange multiple visits to address dissimilar problems in the patient treatment plan. And therefore, instead of addressing the patient’s problems in fewer visits, the grouping system of addressing only one issue at a time leads to more visits, decreasing the overall productivity of the dental clinic. This compartmentalization in a private dental clinic may be difficult to see, but is evident nevertheless. The classic example is the delineation between the dental hygienists and the dentists, where shifting from one area to another leads to much delays and much loss of productive time. Many of the dentists state that instead of doing the different procedures in compartments, one can do them in less overall time together, without the need for more visits. This means that the patients will be able to eliminate their extended times by half, and the dentist will be able to shave off time by avoiding the repetition of procedures that are necessary in each dental visit, such as anesthesia, radiographs etc. The research carried out by Bahri in his own dental clinic is perhaps the most illustrative example of wastage. Bahri was able to demonstrate up to 80% increased performance in the dental office through a series of simple measures to increase productivity. He first removed the hygienist and dentist barrier, and conjoined the two areas of dental care delivery, which lead to increased consumption of time and resources. (Lean Enterprise Institute, 2005) He also aimed to give more with less, and aimed to provide the maximum of services per visit, instead of compartmentalizing the different procedures as done so in dental colleges. This not only saved time within the dental office itself, but also saved time of the reception, which now did not have to invest much time is cataloging the various visits of each patient, and therefore, the pricing and providing customer services. The resources were used less, as the different essential procedures of each visit were cut down to one single visit. The overall productivity increase was easier to see. The only drawback was the increased time the patient would have to spend at the dental chair at one visit, which in the long run, was actually less than the culminate of multiple visits. The introduction of various technological techniques is another way to eliminate waste. Bahri claims that the institution of lean methodology can increase workflow as well as productivity. (Lean Enterprise Institute, 2005) Sadly, the problem with lean methods is that there are very few dentists that have employed lean into their settings and therefore, there is still less evidence to support the theories provided by Bahri. His experiment however is considered the first success story of lean methods application in the dental setup. He is therefore considered a pioneer in the application of lean methodology in dentistry. Many researchers in this area however, do believe that in the dental surgery there are three places where the efficacy of the office starts to get affected. The first and the foremost is the dental chart that is formulated for the patient and is consulted at each visit and even multiple times when the patient is transferred from one dentist to another. The use of chart makes patient handling process much slower, and therefore, the advent of digital record keeping is considered the best method of acquiring information. The second is the use of conventional radiographic procedures, which if replaced by the digital radiography, will save costs as well as time. The third significant factor is the number of remakes that are sent in porcelain crowns. By instituting instruments that are able to record correct shades, there will be saving in time and costs. (Nakai, 2003) Digitization is perhaps the most effective methodology in the current dental setup scenario. This is because digital dentistry helps in dealing with many procedures in less time with more efficiency. It can help reduce the management issues by decreasing manual loads, and fast retrievals. Digital dentistry can therefore play an important role in increasing the efficacy of dental offices. With more researches, newer methodologies are coming to light to understand how better services can be provided to the patients through lean methods. The debate in this regard therefore continues. Conclusion Lean methodology is fast gaining acceptance and recognition around the world as the most progressive method of improving outcomes in an organization. It is now a chief area of research and many are interested in implementing this technique in their organizations. In dentistry, the role of six sigma and lean methodology is considered ideal for reducing waste and increasing outcomes. Dentistry is especially an area of healthcare where the patient is more reliant on the environment to help decide to continue his treatment there. Therefore, a good management with less difficulties and more productivity become the essential and crucial tools for the success of that clinic. In the private settings the proper application of lean methods can help increase the patients’ confidence about the clinic and help in improving the outcomes of productivity of the clinic. References Fransisco Aguado Correa, Maria Jose Alvariz Gil and Lucia Barcos Redin, 2005. Benefits of Connecting RFID and Lean Principals in Healthcare. Working Paper 05-44 Business Economic Series 10. Healthcare Excellence Institute. Bed Management- Decreasing Bed Turn Around Times by 30% site last accessed on July 22, 2007 from www.hei.org HIBCC Annual Conference Australia, 2005 Site last accessed on July 20th, 2007 from http://www.hibcc-au.com.au/conference2005.tm Daniel Jones and Alan Mitchell, 2006. Lean Thinking for the NHS. www.nhs.org Lean Enterprise Institute, 2005. Dentist Drills Down to the Root Causes of Office Waste. Site last accessed on July 22, 2007 from http://blog.leancor.ru/leanvision/LeanDentistStory%5B1%5D.pdf. Lean Concepts in Healthcare- Turning the Heat on Wastage. Journal of Asian Hospital and Healthcare Management, 2007 Roy Nakai, 2003. What do Nordstroms, Wal-Mart and Digital Dentistry Have in Common. Master Dentist Institute. Site last accessed on July 22, 2007 from http://www.masterdentist.net/index.asp?f=articles&id=711 Scott McAlistor, 2007 A Prescriptions for Change: Leveraging Lean Six Sigma to Improve UK Healthcare Delivery. Scottish Executive Research, 2007. Chapter Eight. Implementing Lean in the Public Sector: Critical Success Factors. Six Sigma Systems, 2007. Change Management Methods for Healthcare Providers. James P. Womack, Arthur P. Byrne, Orest J. Fiume, Gary S. Kaplan, John Toussaint. Innovation Series 2005. Going Lean in Health Care. Institute of Healthcare Improvement. Site last accessed on July 22, 2007 from www.ihi.org Read More