Lean Practice Coach

The final step is to continue training and maintaining the standards and standardized processes. The achievements of the first four S’s should be sustained and improved upon. The fifth S has to be built into the daily activities and should be a part of everyone’s job. While sustaining the 5S’s through discipline is advocated as a good thing, at the same time sustaining by design is also desirable. Sustaining by design means automating or simplifying the processes so less work is required to sustain. The most important aspect of any process improvement is sustaining it. Sustain needs to be given attention and focus by all.

S4: Standardization

Standardization means operating in a consistent and uniform fashion. Standardization is making sure that any activity is performed in the same manner in each operatory. A well-defined process for all the key patient-related activities goes a long way into ensuring this. Standardization means that each workstation is organized in an identical manner. For example, each restorative operatory should be organized like each other restorative operatory. This means that each tool, each piece of equipment, and all materials be put in the same place and be accessed the same way. This standardization allows three advantages: 1) each assistant/hygienist/dentist knows exactly where anything they need is located for the task at hand, 2) Standardization allows flexibility in where the work is performed, 3) Standardization makes it much easier to restock supplies and tools, and 4) Standardization increases the visibility of the processes by removing the “looking for” non-value-added time. The essence of standardization is all the activities are done right the first time and every time.

Make sure that the method adopted for any activity is same irrespective of any workstation the patient might be in and for any assistant/hygienist/dentist who might be performing the task. Tools such as checklists, process maps, mistake proofing along with a set of policies and rules can be used to achieve the standardization.

S3: Shine (Cleanliness)

Shine is about keeping the workspaces neat and clean. Cleanliness is a required and desirable part of proper workplace hygiene. As a part of 5S, maintaining neatness should be part of the daily work, not an occasional activity initiated when things get too messy. After sorting and straightening, the premises needs to be neat and clean without any clutter and should be maintained properly. Due attention also needs to be given to aesthetics, lighting and convenience of the patients.

In offices I’ve visited or in which I’ve been a patient, I’ve noticed perfunctory work being done to sanitize the operatory as well as clean-up work, from the last patient, being done after I’ve been seated. Those really don’t inspire confidence…

S2: Straighten (Orderliness)

Straighten refers to keeping the materials, tools and equipment organized in a systematic manner. Identification, organizing and arranging the workplace reduces the time wasted on searching and looking for items required in the dental procedures. Straighten makes the workplace more “system” dependent and people independent.

For the dental office it means:

• Clearly identify all the workplace materials, tools equipment required for a procedure and make sure that they are available at the point of service delivery for that procedure. (“A place for everything and everything in its place.”) For example, all the tools and tool bits can be kept in a stand and labeled. At a workstation, all the materials to be used can be kept in bins and the assistant/hygienist/dentist has to just pick one from the bin.
  
• If the workspace deals with documents either in hard copy for in soft format, a documents storage and retrieval system needs to be designed and implemented to ensure document retrieval within a matter of seconds.
  
• All operatories would be organized in the same fashion. This reduces the time necessary to stock the operatory, and reduces the time to find items in any operatory.
  

S1: Sort

The first S, Sort, focuses on eliminating unnecessary items from the workplace. Sort what is necessary at a workstation from what is not. In a typical dentist office, the staff should remove all materials that are not required for serving the patient at each workstation. For example, a front desk should have only those documents/forms that are to be acted upon during the initial patient check-in. Everything else, such as internal reports, files, advertisements, completed documents, etc., need to be removed.

Whatever is not visible to the patient should be sorted also, including items in a storeroom, stationery cupboards, drawers and cabinets of all the staff. This is essential to make sure that all the unwanted material is actually removed and not just hidden. This allows staff to find materials, when needed, quickly and efficiently. Sort often provides an additional benefit of freeing up storage space.

The workstations need to be redesigned to avoid non-value-added time being required to get ready for a patient Reducing set-up time is essential to maximize flexibility and reduce non-value-added time in the office. Sorting the items in the workstation make it much easier to see whether the workstation is setup properly, or not.

I was recently in an office that several operatories. Although the same procedures were performed in each, they were set up differently. While each operatory usually had the same dental assistant assigned, sometimes assistants would use another operatory. When that happened, there was a lot of looking through drawers to find the right item. This creates a lot of non-value-added time, said another way much patient and assistant and doctor time is wasted when this happens.

In dental offices, patients are the most important part of the entire service delivery process. In order to successfully deliver services to patients, satisfy their needs and increase the likelihood of future business, dentists can make good use of the 5S tool as a basic framework to manage workplace dynamics.

The 5S tool was developed in order to assist the process of Kaizen (continuous improvement) by eliminating the clutter that hides the work processes. This clutter reduces the visibility of the process making it difficult to improve the process.

The 5S tool name is derived from the five Japanese words Seiri, Seiton, Seiso, Seiketsu and Shitsuke. Roughly translated, they mean sort, straighten, shine, standardize and sustain. While the 5S tool was developed in manufacturing, it is clear it has meaning in dentist offices as well.