C Suite Teamwork for the Dental Office

Visibility Wall - make all your needs visible

KAIZEN – Continuous Improvement

    Focus is on small, incremental change (not necessarily huge leaps, innovation)

    Quality Control = quality of people

    “A company that is able to build quality into its people is halfway to building quality outcomes”

    Respect for People

    “Only people produce improvements…machines only degrade over time””

Five Whys – ask why 5 x’s to get to the ….

RCA – Root Cause Analysis

4 M’s

5 S’s

A3s

SMART

Fishbone Diagram – Ishikawa Chart

Make problems visible – not hide them or “not talk about mistakes/problems”

Fix problems permanently – get to the “root cause” and eliminate it.

Focus on the value and respect for people.

Lean Tools

Kaizen

Gradual, unending continuous improvement of processes

Processes must be improved to get improved results

By improving and standardizing activities and processes, Kaizen aims to eliminate waste

GEMBA – make problems visible

the best improvement ideas come form going to the gemba – leadership goes to the departments/wards/units to look for waste and opportunities to improve or practice kaizen.

Elimination of WASTE - 3Ms

All about Waste- Identifying it and Removing it

MURI   =  Waste of overburdening people or equipment/resources

MURA  =  Waste of unevenness, variability in processes

MUDA  =  Waste of using resources without creating added value

Problem Solving – A3s

What causes are preventing us from meeting our target(s)? What are the “root” causes?

5 Whys

Keep asking ‘Why’ until you discover the root cause of the problem

No magic in 5 – 

might be 3, or 7, or 10

Why do we? (conduct orientation in person, fill out multiple forms, take on line training for non MDs)

Identify a project or problem

Write a description

Be objective – customer focus

Maintain a limited scope

Learn the significance or history

Interview, study, read, etc.

2.  Observe and draw workflows (process flows)’

Gemba

Interview staff

Map the process from A-Z (butcher paper)

Identify problem(s) within the process

Confirm findings with frontline staff

3.  Measure the current state

Collect data

Manual (i.e. Paper surveys, counts)

Database (i.e. EMR)

Upstream vs. Downstream

Validate data with frontline staff

4.  Set goal(s) around measurements

Consider what is ideal

Consider what is possible

Engage / speak with front line staff

Be SMART

S = Specific

M = Measureable

A = Attainable

R = Realistic

T = Timely

5.  Analyze the problem and identify root causes

Interview stakeholders (ask the 5 Whys)

Use measurements to identify biggest problem (Pareto)

6.  Identify the future state and countermeasures

Describe/envision the ideal state of the process

Brainstorm solutions to root causes

Select countermeasures and list in A3

Draw a simple future state diagram

7.  Determine how countermeasures will be implemented

Identify stakeholders (all persons affected by the changes)

Ensure the right people are involved/aware

Consider communications

Set timelines for achieving steps/countermeasures

8.  Determine the follow-up plan

Identify how you will maintain the intervention

How will the intervention be “hard-wired”/

What is the visibility plan?

Consider future actions required to improve he outcome

9.  Monitor results

Allocate time for measuring results after implementation

Measure and analyze results

Report results

10. Continuously review the A3

Does the story flow well?

Is it easy to understand?

Is the report neat/organized?

Revise…

Fishbone Diagrams (Ishikawa Charts)

4 Ps / 4 Ms 

Manpower/Personnel

Materials

Method(s)

Machines / Equipment

People

Process

Policy

Principles

5 Ss 

Sorting           

Simplifying

Sweeping

Standardizing

Self Discipline

Data-driven decisions

Multiple sources

Comparable measures allows for “tiering” of programs

Institutional Review / AIRs

Timely, visual and easy to identify trends

Pre-emptive

Easy for Leadership “C Suite” to read

Easy for CCCs to use