Project Managed by: Division of Dental Public Health and Outreach Gemba Roles and Responsibilities The site project team members will collaborate with the Regional Coordinators on a regular basis through site visits to ensure continuous improvement is taking place throughout the duration of the project. To accomplish the goal of continuous improvement, we utilize Lean tools and themes adapted to fit our project. These are fun tools if you embrace them! Sensei "ONE WHO HAS TRAVELLED THE PATH BEFORE" 1 The simplest definition of a sensei is that of a teacher, but the conventional notion of a teacher is not enough. Sure, the sensei will no doubt teach the team stuff about Lean and its tools and techniques, but the biggest part of this individual s role is helping the team to un-learn. For that task conventional teaching methods do not work. Instead, the sensei must work on thoughts and beliefs and, via shared actions, ultimately change the team s values and habits regarding the world of work. 1 The Gemba Walk EVERYONE IS FREE TO JOIN IN WITH THE PROBLEM SOLVING 1 By solving problems in the Gemba (the actual place of action) and using simple methods, the team can more likely understand the direct causes and effects of a problem and solve it. 1 The process of a Gemba Walk, for our purposes, is simple: Get all relevant parties involved by physically walking the workflow. The Tour Guide will take all Gemba Walkers on a real time journey through the clinic and view all areas/procedure places that a patient and clinician would encounter. Tour Guide The Registered Dental Hygienist at each site will serve as the Tour Guide. This individual should prepare the site for the Gemba Walk by ensuring the space is available, activity non-intrusive, and path fully encompasses the workflow. The Tour Guide will begin each Gemba Walk at the point of entry for patients, e.g. the front door, and walk the entire visit through. The Tour Guide can point out important places, stops, and/or bottle necks during the walk but the Tour Guide should progress swiftly so that the discussion can take place after the Gemba Walk in a designated quiet location (i.e. minimize long discussions while walking). Gemba Walkers This activity is meaningless and ineffective unless all the following are present and participate: hygienist, physician, admin, IT champion, and Regional Coordinator. Gemba Walkers should arrive promptly at a designated time, regularly scheduled. Protocol for Gemba Walks Please use the Form for Data Reporting to compile data from codes dropped by the hygienist during visits. The paper Patient Screening Form guides the hygienist during a visit but data are also pulled from the Electronic Dental Record (EDR). Data are important and show progress via tangible, measurable outcomes made from process improvements implemented at prior Gemba Walks. Regional Coordinators can use the Gemba Walk Tool to guide the activities of site visits. 1. Start every Gemba Walk (site visit) at a designated, specified regularly scheduled time and day Regional Coordinator posts latest data and prior RIE* for all Gemba Walkers to view prior to the activity 2. Tour Guide leads Gemba Walkers through the entire Value Stream (patient visit) from start to finish Avoid excessive talk during the Gemba Walk and save extensive comments to the end for discussion Gemba Walkers should think about the latest data, good or bad, and how it relates to workflow 3. Gemba Walkers should proceed to a quiet, non-intrusive space for discussion after the activity Discuss all areas for improvement; Ask Why? 5 times for each issue followed by asking 5x How? 4. Create at least 1 Rapid Improvement Event (*RIE) to conduct through next week; Post that on the designated board Data for the previous month should be emailed to girdwojr@udmercy.edu by the second Tuesday of the subsequent month. 1 Cooper C. The Little Book of Lean. CreateSpace Independent Publishing Platform; 2012.
Project Managed by: Division of Dental Public Health and Outreach Site: Form for Data Reporting 10/2017 11/2017 12/2017 01/2018 02/2018 03/2018 04/2018 05/2018 06/2018 07/2018 08/2018 09/2018 Totals UDM1 UDM2 UDM3 UDMP UDMC Total D0191 D1110 D1351 Total D0191 D1110 D1351 Total D0191 D1110 D1351 Total D0191 D1110 D1351 D0191 D1120 D1206 D1351 REF Please email data for the previous month to girdwojr@udmercy.edu by the second Tuesday of the subsequent month. Regional Coordinator can produce charts and graphs using this data to show a visual representation of data during the site visits.
SITE NAME: TODAY S DATE OF SITE VISIT: EACH WEEK: Regional Coordinators will visit the site and work with the Registered Dental Hygienist to compile data entered on the paper forms. The Regional Coordinator will present these data to Gemba Walkers the following week. What is MOM S average date of birth? DATA RECORD Patient Screening Form How many MOMs are part of a Centering Pregnancy program? What is BABY S average expected birthdate (due date)? / / Yes No / / ABOUT YOU! # Yes # No Is this your 1st pregnancy? Have you ever visited a dentist for pain or cavities? Do you currently have any pain in your mouth or your teeth? Have you had any cavities, fillings, or teeth pulled during the past year? Have you seen changes (white or brown spots or holes) on your teeth this past year? Do you drink juice or sugary drinks or eat sugary snacks between meals? Do you brush teeth twice daily with a fluoride toothpaste? Do you use tobacco products? REGIONAL COORDINATORS WILL RECORD COUNTS (QUANTITIES) WEEKLY USING GRID BELOW CARIES OTHER PATIENT Since last visit... CARE FOR RISK RISK CARE HISTORY FAMILY 1 2 3 P TRIMESTER + / - Saliva-Check Mutans Test High Moderate Low Periodontal Disease Risk Gingivitis Risk Infection Risk D0191 Assessment for Mom D1110 Prophylaxis for Mom D1351 Sealant for Mom # New Cavities # New Fillings # New Extractions # D0191 Assessment (Child) # D1120 Child Prophylaxis # D1206 Fl. Varnish (Child) # D1351 Sealant (Child) REFERRAL to Dentist Date with Dental Completed Dental Visit
Project Managed by: Division of Dental Public Health and Outreach Pre-Gemba Detailed Description of Gemba Walk Activity Regional Coordinator will acquire EHR/EDR data from IT Champion (See: Form for Data Reporting) Regional Coordinator should make a visual chart or graph to show Gemba Walkers during site visit Site Team (Gemba Walkers) will confirm their attendance at specified regular day/time every week Site Team should review the prior week s data and board before the Gemba Walk Regional Coordinator will print and bring appropriate handouts (e.g. blank A3 and charts) Regional Coordinator will check with Site Team to see if any supplies (e.g. paper surveys or saliva kits) are needed Tools for Gemba Regional Coordinator will bring most recent data on Form for Data Reporting Regional Coordinator will collaborate with hygienist to complete DATA RECORD Patient Screening Form Regional Coordinator will print and bring appropriate handouts (e.g. blank A3 and charts) Regional Coordinator will bring recording tools (e.g. paper, pencil, stopwatch) including 5x Why? if needed During Gemba 1. Start every Gemba Walk (site visit) at a designated, specified regularly scheduled time and day Regional Coordinator posts latest data and prior RIE* for all Gemba Walkers to view prior to the activity 2. Tour Guide leads Gemba Walkers through the entire Value Stream (patient visit) from start to finish Avoid excessive talk during the Gemba Walk and save extensive comments to the end for discussion Gemba Walkers should think about the latest data, good or bad, and how it relates to workflow 3. Gemba Walkers should proceed to a quiet, non-intrusive space for discussion after the activity Discuss all areas for improvement; Ask Why? 5 times for each issue followed by asking 5x How? 4. Create at least 1 Rapid Improvement Event (*RIE) to conduct through next week; Post that on the designated board Areas of Focus Patient Care: assessment and provision (prophylaxis and sealants) Patient Education: sugary drinks, sticky foods, brushing with fluoride o Saliva Test Study: integrating to work flow, usefulness, patient education tool/survey, bacteria transfer Recording Care and Education: dropping codes Outreach: seeing the most patients, maximizing schedule and work flow o Family Care: any care given to children or family members of mother who also attend pre/post-natal visit 5 Why Exercise Review the data. Identify any area for improvement; write here:. If not currently ideal, simply ask 1. Why did this occur? (Or, why is this less than ideal?) 2. Why did this occur? (Or, why is this less than ideal?) 3. Why did this occur? (Or, why is this less than ideal?) 4. Why did this occur? (Or, why is this less than ideal?) 5. Why did this occur? (Or, why is this less than ideal?) Record the issue (reason for action) and initial state (from data). Include 5x Why answers on A3 Gap Analysis. The gap is also the difference between initial (current) and ideal (target) states. Only create solutions after all this work is done!
A3 PROJECT: OWNER: DATE: / / 2018 1. Reason for Action 4. Gap Analysis 7. Completion Plan 2. Initial State 5. Solution Approach 8. Confirmed State 3. Target State 6. Rapid Experiments 9. Insights
Example of a Site Visit Regional Coordinator gets EDR data from IT Champion; Prints and brings a completed Form for Data Reporting to the site along with a data trend graph Regional Coordinator contacts all members of Site Team (Gemba Walkers) day before visit and confirms their attendance at specified regular day/time Site Team members individually review the prior week s data and board before the Gemba Walk, just a quick glance (2-3 minutes) as a brief reminder Regional Coordinator prints and brings appropriate handouts (e.g. blank A3 and charts) and any supplies (e.g. paper surveys or saliva kits) that are needed Group gathers at the designated, specified regularly scheduled time and day Regional Coordinator posts latest data and prior RIE (A3) for all Gemba Walkers to view prior to the Gemba Walk Gemba Walk begins Team physically walks the entire work flow During the walk, hygienist mentions that there is not enough time to conduct a prophylaxis during the first trimester visit; Regional Coordinator writes that down When the group returns to the meeting place (white board area where the Gemba Walk starts and ends), the Regional Coordinator points to the data chart that shows a very low # of prophylaxis were done the previous week. The Regional Coordinator repeats the concern expressed by the hygienist that there is not enough time to conduct a prophylaxis during the first trimester visit. This begins a 5 Why exercise: Why #1: Why is there a low # of prophylaxis occurring at first trimester visits? A: Not enough time Why #2: Why is there not enough time? A: First trimester is when mom gets a full physical Why #3: Why are we doing prophylaxis at first visit as opposed to second visit? A: That s the way we ve always done it Why #4: Why have you always done it that way? A: Mom really needs a prophylaxis immediately! Why #5: Why do we feel this is the only way for mom to get a prophylaxis done immediately? A: We never thought of another way Team then proceeds to begin an A3 Rapid Improvement Experiment PROJECT: Increase the # of prophylaxis received by patients this month OWNER: Jane Doe, RDH DATE: 1 / 11 / 2018 1. Reason for Action 4. Gap Analysis 7. Completion Plan We are seeing moms who need a prophylaxis immediately or as soon as possible (Note: Make sure your reasons are always patient-centered) We estimate 20% of moms (5 of 25) need prophylaxis and, since we did 1 last month, we want to do 4 more this month. Hygienist will record need-based data and IT Champ will provide provision rate data to Regional Coordinator for review at next Gemba Walk. 2. Initial State 5. Solution Approach 8. Confirmed State We recorded 1 prophylaxis (D1110) for a pregnant mom this past month. That was 4% of all patients (or, 1 out of 25 received prophylaxis). We need to (a) assess the need and (b) meet the need. Does not occur until subsequent Gemba Walk after RIE 3. Target State 6. Rapid Experiments 9. Insights We want all moms who need a prophylaxis to get one. (Note: Do not aim for 100% provision if not all moms need care; goals remain patient-centered) a. Record how many moms really need a prophylaxis b. Provide those services either (i) during the OB visit or (ii) through a referral to the dentist Does not occur until subsequent Gemba Walk after RIE