Building a Lean Dental Practice: Trimming Waste While Enhancing Care

Bringing lean principles into a people-centric field like dental care seems counterintuitive. After all, this business management strategy was created for motor vehicle assembly lines — how can it possibly translate to providing better patient care in a dental setting? However, it is important to recognize that every dental practice, like any other organization, has its own set of processes that they follow. Whether it is scheduling patients, managing appointments, conducting exams, or overseeing administrative tasks, processes are an inherent part of your practice. Building a lean dental practice will help you control those processes, reduce waste, and, ultimately, improve patient care. 

What is Lean, and How Does it Translate to Dental Practices?

Lean is an idea that was developed in the manufacturing industry but has since proven its versatility and applicability across various fields. Originally conceived as part of the groundbreaking Toyota Production System, lean thinking has evolved into a universally applicable method for improving processes, reducing waste, and optimizing outcomes.

This strategy is built on an ever-continuing cycle of steps:

• Identify value: What do patients genuinely value in your product or service?
• Map the stream: What's the step-by-step process for delivering value to the patient?
• Create flow: How can you optimize task sequences and timing for a smoother workflow?
• Establish pull: How can you deliver value based on patient demand?
• Continuously improve: Now that you have corrected that issue, what else can you fix?

These five stages can guide your dental practice to improvement that will enhance patient care, streamline your scheduling and staffing, and help you eliminate wasteful practices that slow down your growth.

Identifying Value Within Your Practice

The value of a practice is based not just on the services the patient receives but also on why they choose your practice to receive them. For general practitioners, it may be your chairside manner, your team's expertise, the convenience of your location, or any other number of things. For specialists, your value will often be in those niche services that set you apart in your field. Understanding what truly matters to your patients and why they select your practice is the foundation for improvement.

One effective way to identify the most valuable parts of the services you provide is through patient surveys. You can send these surveys out after treatment or periodically to your regular patients.

Here are tips for completing them.

 

Patient Survey Dos and Don'ts
Do:	Don't:
Keep the survey short and focused. Patients are more likely to complete surveys that don't consume too much of their time. Frame questions in plain and understandable language. Include a mix of multiple-choice questions, rating scales, and open-ended questions to gather diverse feedback. Assure patients that their responses will remain anonymous and confidential. Share the results and any actions taken or improvements made due to patient feedback.	Avoid overwhelming patients with an excessively long survey. Avoid using medical or dental jargon that patients might not understand. Don't assume patients are aware of internal processes or technical terms. Don't disregard or downplay negative feedback; use it as an opportunity to identify areas for improvement. Avoid excessive survey requests. Sending too many surveys can annoy patients and decrease response rates.

 

Visualizing Excellence: Mapping the Dental Care Process

After compiling your patient survey data, you know what brings the most value to your business and patient experiences. You also have the patient journey in your hands. By reviewing all the steps, you took to get them to that point, you can identify areas where improvements are needed and opportunities for enhancing the overall patient experience.

You can also review the stream for patients with less positive experiences. This can help you identify deviations in your process that may have resulted in that dissatisfaction. For example, you might take two patient surveys, one that scores you highly and one who scores low, and then map out their two separate patient journeys.

 

Patient Journey 1

Patient Journey 2

Appointment scheduling: The patient easily used the online system. Pre-appointment communication: They immediately received a confirmation email and a series of follow-ups. Arrival and check-in: They received a warm welcome and efficient check-in. Wait time: There was a minimal wait. Treatment: Excellent care, clear explanations, and Q&A were given. Post-treatment: There were clear post-care instructions and a Q&A session, followed by an email. Follow-up: Post-visit follow-up is scheduled and attended. Billing and payment: Transparent billing processes ensure no surprises to the patient. Departure: The patient gives five out of five stars.

Appointment scheduling: The patient easily used the online system. Pre-appointment communication: A confirmation was sent with no follow-ups. Arrival and check-in: There was a prolonged wait during check-in. Wait time: There was a moderate wait time in the reception area. Treatment: Excellent care, clear explanations, and Q&A were given. Post-treatment: There were clear post-care instructions but no email follow-up from the practice. Follow-up: There was a lack of post-visit follow-up from the practice. Billing and payment: Transparent billing processes ensure no surprises to the patient. Departure: The patient leaves the practice dissatisfied, giving two stars out of five.

 

With both negative and positive patient journeys mapped, you can see areas for improvement. You take this information to the next stage, where you correct the inefficiencies and errors in your process.

Creating Smooth Digital Dental Workflows

Now that you have the patient workflow clearly mapped out, you can start to notice inefficiencies affecting the patient’ s experiences or delaying your staff. For example, in the journey of Patient 2, there were several gaps or errors in the process that led to a poor experience.

Meanwhile, the positive journey of Patient 1 shows that the practice has the resources to provide a streamlined experience. It started when Patient 1 received a follow-up, reminding them of their appointment and allowing them to complete necessary forms online.

Meanwhile, in the Patient 2 experience, no reminder emails or forms were sent. That caused the patient to fill out the forms at the office, delaying their appointment and increasing their wait time. It also had a domino effect, delaying the wait times of the patients behind them.

So, the practice closes that gap to keep it from happening again. They set up their scheduling system to send out automated reminder emails to patients before their appointments rather than manually sending messages. That closes the possible gap in the stream and improves the patient experience without burdening the dental team.

Establishing Pull by Being Data Driven

The goal of pull in lean is inventory efficiency. Workers receive new materials just as they run out, with no gap in the process. However, this looks a bit different in a dental practice. You can't order a new batch of patients if your team has nothing to do, nor can you return them if you have more than your staff can manage.

In dental care, "pull" means aligning your services with actual patient demand. It is about ensuring you have the right appointments available when patients need them. This requires careful scheduling, effective resource allocation, and a flexible approach to accommodate fluctuations in patient flow. You should track a few metrics within your practice management software to make better decisions about scheduling to improve pull.

 

Appointment Utilization Rate: Measures the percentage of appointments that are utilized, helping you understand appointment efficiency. (Number of Appointments Used / Total Available Appointments) x 100	Patient No-Show Rate: Indicates the percentage of scheduled appointments that patients do not attend, helping you identify areas for improvement in appointment management. (Number of No-Show Appointments / Total Scheduled Appointments) x 100	Lead Time: Measures the time it takes for a patient to get an appointment, helping you assess scheduling efficiency. (Appointment Date - Date Requested) or (Appointment Time - Request Time)
Cycle Time: Evaluates the time taken to complete specific processes, enabling you to identify bottlenecks. (End Time - Start Time) for a specific process (e.g., patient check-in to check-out)	Resource Utilization Rate: Determines how effectively your dental providers' time is being utilized. (Actual Patient Hours / Available Provider Hours) x 100	Patient Wait Time: Measures the time patients spend waiting, helping you minimize patient wait times. (End of Treatment - Appointment Start Time) or (End of Check-In - Start of Treatment)
Provider Productivity: Measures the efficiency of each dental provider in terms of the number of patients they see. (Number of Patients Seen by Provider / Provider Hours Worked) x 100	Cancellation Rate: Tracks the percentage of appointments that patients cancel, allowing you to assess the impact on scheduling. (Number of Canceled Appointments / Total Scheduled Appointments) x 100	Patient Satisfaction Score: Gauges patient satisfaction, which indirectly reflects the effectiveness of your scheduling and patient flow management. (Total Positive Feedback / Total Feedback Responses) x 100

 

Continuously Improving Your Lean Dental Practice

It is ironic that surveys were the first step in lean dental practice management because they are also the last. Regular patient surveys will allow you to continue identifying value and gaps in your practice's process that could lead to further improvements. This step merges into the first, starting your entire process improvement again based on your patient's needs.

This continuous feedback loop supports your lean dental practice as you identify areas of improvement. Ongoing commitment to surveying and listening to your patients helps you drive continuous improvement and enhance the overall patient experience. It ensures that your practice remains adaptable and patient-centric, consistently striving for excellence in patient care.