Sustainable dentistry: Can goals for leaner lifestyle spill over into the workforce? Sure, it can.

Can your goal for a leaner lifestyle spill over into the workforce? Sure, it can.

By Judith M. Stein, RDH

The "lean green dental machine" sounds more like a cheer than a professional motto. Well, hang on to your megaphones because today I believe lean and green should be cheered on. Our culture is all about becoming greener and living more sustainably. We need to work toward creating a world where everything we do is balanced against people, plant, and profit.

Five years ago I set out on a quest of sorts. I was looking for ways to live a more sustainable lifestyle. I was looking for avenues to positively affect people, planet, and profit. I eagerly shared my newfound enthusiasm in an article, "Journey toward sustainability," published in RDH magazine in March 2011.1 And the quest began.

To date, the dental practice I'm a part of has eagerly embraced sustainability concepts. Over these past four years, we have recycled approximately 144 95-gallon refuse containers of recyclable material. We have reduced our paper use and postage costs significantly with electronic newsletters. We've simplified our ordering choices more responsibly by reducing product duplications and ordering in bulk when possible.

We've also given back to the community these last four years. Our efforts have included sharing dental fun with preschoolers, working on Habitat for Humanity buildings, collecting items for schoolchildren in need, collecting items for our military personnel, adopting families during the winter holidays, and offering encouragement to survivors of domestic abuse. The entire dental staff has selflessly shared their time and talents with the community, and we've had a blast doing so. Sustainable living works!

I'm excited to share that the story doesn't end there. We have more to add to our environmental enthusiasm, something I believe truly complements sustainable living. Let me introduce you to the concept of lean, and how it's connected to the world of dentistry.

I recently read the book, "² Second Lean: How to Grow People and Build a Fun Lean Culture at Work & at Home," by Paul A. Akers.² Although this book is primarily directed to a manufacturing audience, as soon as I realized living lean focused on the person rather than the process, I knew I could apply the ideas to the dental world. I was hooked. I have found the elements of living and working lean very simple to plug into my personal and professional world. I am completely geeked about lean living and I'd love to share that with you!

Let's start at the beginning. Although there are many variations to the lean philosophies, Paul offers his three simple concepts and calls them "The Three Pillars of Lean."

1. To see waste (which will lead to eliminating waste).
2. Continuously improve everything, everybody, every day.
3. Make before-and-after videos of your improvements. (I chose to photograph rather than videotape my lean applications.)

Paul's quest took him to Japan to study lean concepts from the Toyota Manufacturing Company. He then took these practices and applied them to his own business, FastCap LLC. Now I too am enthused and excited to live a more lean life. I continue to see ways every day to apply lean living to dentistry and my personal life. And why not?

Here are only a few lean ideas I recognized that either already existed in our dental practice or could be implemented in our practices.

Clean up your workstation

It's easy for many of us to get used to the way things are. You know, the small sticky notes attached to workstations that alert you to process expectations. In my world, we even color coded these sticky notes. I'm not judging these conditions. I'm just becoming aware of ways to improve them. One simple way I got lean with a workstation computer monitor was to remove the sticky notes, type out their messages onto computer paper, laminate the message, and reattach it to the computer monitor. Please note, I did not change any wording. I only cleaned up the appearance of the message on the computer monitor.

Improving your work processes

For years I have watched one of my coworkers efficiently change over her operatory. After educating myself on lean living, I now realize she's been practicing lean skills all along. My coworker moves her dental tray into the instrument processing area before she dismisses her patients. This simple step allows her to begin the sterilization process more efficiently. She does this so seamlessly that no one even notices. By the time she returns to her operatory, her instruments have been in the ultrasonic and she can then proceed with her sterilization routine in her operatory. She is cognizant of the sterilization chain and never breaks it. She has found a simple and more effective way to manage her time.

Streamline the nitrous oxide and oxygen tank process with a simple sign-off board

In order to help manage costs and efficiency, we turn off the main nitrous oxide/oxygen tank switches after each patient. The problem was, what if someone else was also using the system and someone inadvertently turned it off? Before we began using a sign-on and sign-off board, we had to physically enter each operatory to see if the system was in use before turning off the switch. This was a waste of precious time. Today, right next to the main nitrous oxide/oxygen switch is a small board that we initial when we begin using the system. When we are finished, if someone else has initialed behind us, we do not need to turn off the main switch. If no one has initialed behind us, the tanks can be turned off with confidence. This simple lean process has resulted in less time and money wasted.

Waiting time is wasted time

Waiting time is a big issue for lean living. Waste occurs during waiting. How many of us have to wait for a doctor to perform a periodic exam? I wonder how many doctors have had to wait for dental practitioners to complete needed tasks as well. We operate as a team. Each member's time is valued. Applying lean concepts to this challenge is possible. In my opinion, less time is wasted for everyone if the doctor will come in and perform an exam anytime during the appointment rather than waiting until the end of the appointment. At the beginning of appointments, medical histories are reviewed, radiographs are taken, an oral cancer exam is performed, a periodontal exam is performed, and other information is collected. If the doctor comes in at his or her convenience after this information is documented, it can be far more efficient. Your doctor may find more flexibility in his or her schedule by applying this method. This is especially true if there is more than one hygienist working in the practice.

If waiting is an issue in your office, I encourage you to bring up the topic in a way that validates both sides of the equation. Honor each other's time when you discuss ways to reduce wasteful minutes that could be spent better serving the dental practice. Don't make this a battle. Who knows? Your discussion might lead to an even leaner method of dealing with this issue!

Use instant messaging functions

Whether you work with a dental software program or want to use a Bluetooth³ headset with a microphone, capitalizing on this technology is a wonderful way to make communication more effective and lean. Think about the time wasted walking around the office when you need information. But a word of caution about instant messaging. Make sure your messages are professional and confidential. If your operatory is set up in a way that allows patients to view your computer, you'll need to use the instant messaging differently. I erase old messages to prevent HIPAA violations. I also explain to my patients why I'm instant messaging my colleagues. If you're using Bluetooth technology, please be considerate of your patients. Always inform them before you begin talking to someone outside your operatory.

Preload dental educational material onto your operatory computer

You can easily access a video on dental health instructions for your patients to watch if this information is preloaded onto your computer. My office manager created a simple shortcut button that immediately takes us to a specific dental site. Home-care instructions can be taken to the next level if patients not only hear the information but can also see it. If you do not have access to a computer, make preprinted business cards with links to these sites. There is a plethora of dental education websites out there. Some of my favorites are "Kids teach kids about dental hygiene"4 and "Waterpik Ultra Water Flosser-Dental professional shows how to use,"⁵ both on YouTube. Taking a few minutes to preplan can help foster an even leaner atmosphere in your dental practice.

Be creative with your huddles

Brainstorm with your dental staff different ways to use morning huddle time. We set aside 10 minutes a day to review our schedule and any pertinent updates. Some offices share inspirational quotes, thank-you notes from patients, and constructive feedback. Author Paul Akers suggests reading from different motivational books each morning. He has encouraged and fostered communication skills in his employees by rotating the job of leading staff meetings. There are many different ideas and methods to prevent complacency. As John C. Maxwell said, "Change is inevitable; growth is optional."6 I challenge you to let go of fear, embrace change, and become creative with your team discussion time.

Thanks for joining me and reading this article. I've offered just the tip of the iceberg of ideas on lean dentistry. If somehow your lean curiosity has been awakened, I'd love to hear from you! Be proud of your ideas and achievements! As Paul Akers says, just go "fix what bugs you." That is my challenge to you. Now, get lean and stay lean! RDH

JUDITH M. STEIN, RDH, is a 1981 graduate of Kellogg Community College in Battle Creek, Mich. Judy has enjoyed a variety of professional opportunities in her hygiene career, is committed to lifelong learning, and is now employed in private practice. The author is an active volunteer in several professional, community, and faith organizations. She can be reached at [email protected].