Redesigning an oral health visit for kids who need sealants—Part 2

In part 1 of this post, I described the work of a clinic team seeking to add sealants to an exam visit.  It took more time to add the sealant steps in an initial test.   I outlined advice to reduce exam time, relevant to situations where there is more demand for appointments than the clinic can meet.

The clinic team tested a change, which is an active version of the basic Lean advice to grasp the situation by interacting with the actual work.  Go see the work.  As a rule, circumstances and opportunities to improve work can’t be fully comprehended without the catalyst of observation.  

Let’s dive a little deeper into opportunities for improvement.

More opportunities to include sealants in visits for kids

The team’s first test cycle provoked a couple of improvement ideas:  have sealant ‘kits’ ready for the provider and educate parent/guardians ahead of the visit to reduce or eliminate need to discuss treatment options during the visit. 

These are examples of reducing set-up time, step 2 in the Goldratt sequence that  I introduced in part 1.  For more on methods to reduce set-up time, see this post.

Now repeated test cycles via PDSA with the aim to get sealants done efficiently will almost surely yield improvement.   Can the clinic team improve more quickly?

To increase the pace of improvement, follow the Goldratt sequence to go after typical opportunities that are usually the easiest to tackle and fastest to change:   the improvement team first should look for delays and unplanned waiting.   How?  Observe another visit with a kid who needs sealants; pay special attention to delays and unplanned waiting

* Using Taiichi Ohno’s original categories developed at Toyota, Lean advisers characterize waste in seven or eight types; see for example Lean Lexicon (2008), LEI, Cambridge, MA, p. 88.  The Goldratt approach focuses on a subset of the wastes.

PDSA opportunity for supervisors and managers

“Go See” is only part of the Lean mantra.  The full statement is “Go See, Show Respect, Ask Why,” discussed here.   

One way to show respect to providers and staff:  listen to their issues and aim to remove ‘burrs under the saddle’ BEFORE you ask them to adopt new ways of working, piled on top of a jammed schedule.   Can you take something away from a busy provider’s work day?

Try an open-ended question or two with your staff.  Ask what gets in their way and wears them out.  And ask if they have any ideas to make the situation better.   Start with one staff person, a test of ‘size 1.’ What do you predict will happen when you ask your questions?  Run the test and reflect on what occurred.   You’re likely to get some new ideas to test using Plan-Do-Study-Act.