APPLICATION OF LEAN
SIX SGMA
APPROACH IN DENTAL
OPDS
HEALTH SERVICE DELIVERY & OPERATION MANAGEMENT
Course instructor: Syed Ahsan Nawaz 
 GROUP MEMBERS 
SYEDA TAYABA FATIMA 20212-28993B 
AMTUL HAI NOOR 
ZARA KHAN 20212-29213
ZAINAB FAROOQ 20212-29281
AAMIRA JAWED 20212-29242
 LEAN SIX SIGMA
APPROACH 
• Lean Six Sigma represents a
methodology for overall organizational
culture change.
•  At its core, it is a process improvement
approach for eliminating inefficiencies and
improving work processes by identifying
the defects’ root causes. 
 Analyz
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DMAIC: The 5 Phases of the
Improv
process
Lean Six Sigma Process
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 the perform
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ance
SIX SIGMA APPLICATION
ON DENTAL OPDS

SCENARIO 1 
 Non-availability of dental materials and x-
ray 
SCENARIO 2
Poor Sterilization of instruments 
SCENARIO 3
Long waiting time and appointment 
 NON AVAILIBLITY OF
DENTAL MATERIALS
AND XRAYS  IN OPD
DENTAL SURGERY
Dental plunger, LA, cotton balls, saline water
PROSTHODONTICS
Dental impression trays, impression materials
ORTHODONTICS
Brackets, composite
OPERATIVE DENTISTRY
Rubber dam, composite material, dental files
PERIODONTOLOGY
Scalers, polishing material 
XRAY DEPARTMENT 
Xray films
 LEAN SIX SIGMA APPROACH TO
OVERCOME NON AVAILABILITY OF
DENTAL MATERIALS IN OPD 
DEFINE:
•  In dental OPD we need different materials in hand to
perform dental procedures but in our hospital there are
many instances where we as a dentist experience non
unavailability of many materials which causes delay in
procedures as well as patients dissatisfaction.
• Our goals are to decrease patient dissatisfaction and delay
in procedures. 
MEASURE: 
• In routine practice, it is the job of dental OPD  in charge who
order the daily stock, directs the store officer to arrange
daily stock of materials before the OPD. 
• However, due to delay in ordering of all the required
consumable items by OPD  in charge, procedures are
delayed. 
 regarding the
In this regard,ofa daily
performance
 KPI REGARDING THE PERFORMANCE OF OPD INCHARGE
monitoring/task
OPD Incharge toto do
checklist
measure willthebe
designed for OPD
timeliness for
incharge to check
arrangement of stock
the unavailability
and delays in of
items and
arrangement. arrange
All the delays inIt willthe
be
required
associatedstock
withprior
Job
arrangement/unavailabili to
procedure.
Appraisal ofOPD
the OPD
ty of items need to be
incharge
in charge. must document
calculated and data will
the daily monitoring
be prepared to measure
checklist for stock in
 ANALYZE THE
PROCESS
•  After getting a substantial amount of data, the root cause in
delays in arrangement or unavailability of stock in ODP can
be calculated which includes: 
• OPD in charge not reviewing the list of procedures before
OPD
• OPD in charge Do not have an updated list of items required
for a particular procedure
• Lack of inventory control mechanism
• Lack of communication skills
• JD of OPD In charge not communicated or provided
• Casual attitude by OPD in charge

Moreover, the data of daily monitoring checklist must be compiled on

monthly basis and analyse it to measure the frequency at which OPD faced
unavailability of items at the time of procedure. This data can also be linked
with the performance of the OPD in charge 
IMPROVE:
•  In this step, the OPD manager plan steps to deal
with the issue. 
• Develop departmental OPDs for the timely
arrangement of stock
• Provision of an updated item list of each procedure
to OPD in charge
• Provide JD to OPD in charge and explain the work
responsibilities
• Documentation of daily monitoring checklist prior to
OPD
• Arranging training sessions on time management
and communication skills
CONTROL:
 Revise departmental SOPs to include the newly developed
criteria of daily monitoring checklist for stock in OPD and
updated list of items for each procedure. Furthermore, 
• In this way our OPD will be able to deliver cost effective,
timely and quality services. 
 Scenario 2: Sterilization Process In
DUHS
• Dow University Dental hospital caters to approximately 250 to 300 patients
daily.
• The high volume of patients is accompanied by a weak system of tracking
equipment and instruments.
• An efficient sterilization process allows reusable dental instruments to be
more quickly available for healthcare activities.
 Existing Procedures:
• Instruments are sterilized in the morning and distributed
overall in respective departments.
• Every department has its own setup for disinfecting
instruments.
• Every instrument used throughout the day is placed in a
dish filled with disinfectant.
• At the end of the day, all instruments are packed and sent
for sterilization.
• The department receives sterilized instruments the next
day.
 Loopholes in the Process:

• Due to high patient flow most instruments get used by 1

pm.
• The department has to send the patient back because no
procedures can be performed after 1 pm.
• The cycle is performed once a day only.
• This leads to delays in the process and a reduction in
patient’s satisfaction levels.
 Application of Lean:
• Throughput time: refers to the total amount of time that it takes to run a
particular process in its entirety from start to finish (waiting till transport)
• Takt time: the rate at which you need to complete a product in order to
meet customer demand.
• Throughput time:
• Waiting - the time for instruments to reach the sterilization department is
usually 5 hours
• Transport time - the time taken by the instruments to get sterilized and
transported back to the department 30 minutes
• Process time- 60 minutes
5S:
Six Sigma: DMAIC (to improve the efficiency and effectiveness of an organization's
existing processes)

• Define: sterilization process issues – non-availability of instruments – reduced

patient satisfaction
• Measure: checklist of instruments sterilized with the time of sterilization, check
and balance (assign house officers and assistants to keep track of instruments –
HOs keeping instruments), set a protocol for sterilization (check-in & checkout
time), individuals to assist the dentist performing the case
• Analyze: problem identified in Lean (delayed transport, no check n balance of
sterilization dept, all instruments in one pouch – chances of contamination high)
• Improve: Training of Hos and staff, Protocols update, incentives (best HO on the
basis of following protocols and performance as well)
• Control: regular checks to ensure sterilization protocols are being followed and
there is no delay in the whole process
 DEFINE
PATIENT WAITING TIME IN DENTAL
OPD BASED ON ASSUMPTION

Aim Of the Study

Aim Of the Study
The two main objectives of the study are:
The two main objectives of the study were:
• Identify the factors that affect waiting time
To study the patients’ waiting time in the outpatient clinic, with a view to identify the factors that affect waiting time and
and recommend ways of minimising the delay
recommend ways of minimising the delay
To use the six sigma technique to identify the delay and improve management capabilities
• To use the six sigma technique to identify the
delay and improve management capabilities
 DEFINE
TYPES OF WAITING IN OPD DENTAL CLINIC

• WAITING TIME
Defined as the total time from registrationAim
untilOfconsultation
the Study
The two main objectives of the study were:
and treatment with a dentist.
To study the patients’ waiting time in the outpatient clinic, with a view to identify the factors that affect waiting time and
recommend ways of minimising the delay
• REGISTERATION TIME
To use the six sigma technique to identify the delay and improve management capabilities
Defined as waiting time from the moment patients submit a
clinic card or referral letters at the counter until getting a
call from the dentist . During this time the payment process
and record classification are made. Registration time is part
of patient’s waiting time.
 MEASUR
 SAMPLE SIZE E
This study conducted at the outpatient dental clinic
Respondents of this study are patients, staffs
dentist and assistant at the outpatient clinic.

Six SigmaRESPONSIBLE TOTAL

specifies a very high standard of quality achievement. It utilizes a variety of existing project management,
statistical and analytical tools
PATIENTS PER DAY 10

DENTIST 3

ASSISTANT 3

ADMINISTRATIVE STAFF 7
 MEASUR
 DATA & COLLECTION METHOD E

Three major collection methods used in the study are:

• The first method is observation process flow.

Six Sigma specifies a very high standard of quality achievement. It utilizes a variety of existing project management,
• Second method is Voice of patients statistical
via and analytical tools
interview
(VOP) is obtained using standardized questionnaire
with 150 patients.
 OBSERVATION ANALYZE
PROCESS FLOW OF DENTAL CLINIC
WAITING TIME
WAITING TIME
INCREASE
INCREASE

VISIT TO COUNTER
WAITING TIME FOR
PATIENT ARRIVE FOR REGISTRATION &
TURN
APPOINTMENT

WAITING TIME
INCREASE

VISIT TO COUNTER
CONSULTATION TREATMENT
FOR PAY FEE

EXIT
 ANALYZE
TIME TAKEN TO ATTEND THE PATIENTS
(Assume SAMPLE SIZE of 150 PATIENTS)
When process flow of dow was observed to capture the waiting time, it was assumed
that out of 150 patients, 50 patients were attended within 10 minutes; 70 patients were
attended within 10-20 minutes; 25 patients were attended within 20-30 minutes and 5
patients were attended more than 30 minutes.
 ANALYZE
WAITING TIME IN OPD DENTAL CLINIC
(ASSUME SAMPLE SIZE OF 150 PATIENTS)

Regarding waiting time OF DOW OPD it was assumed that out of 150 patients, 60
patients had to wait up to 10 minutes; 5 patients had to wait within 10-20 minutes, 15
patients had to wait within 20-30 minutes and 30 patients had to wait more than 30
minutes.
 ANALYZE
VOICE OF PATIENT (Dental dept) VIA INTERVIEW
(Assume SAMPLE SIZE 15O PATIENTS)

It was observed that 20% patients take prior appointment whereas 80%
patients come Walk- in
 ANALYZE
VOICE OF PATIENT (Dental dept.)VIA INTERVIEW
(Assume SAMPLE SIZE 15O PATIENTS)

Out of 150 patients, 20 patients felt very good behavior; 90 patients felt good, 25 patients
felt bad and 15 patients felt very bad behavior from the side of reception staff.
 IMPROVE
CAUSES OF DELAY IN INCREASING WAITING TIME

• Single Registration counter

• Staff weekly work schedule not allign
• No online appointment system
• Irregular calling sequence
• Lack of communication by administrative staff
• Registration form is lengthy & difficult to fill
• Dentist not on time
• Unskilled dental assistant
• Low space for patient sitting
 IMPROVE
COUNTERMEASURE TAKEN FOR REDUCING
WAITING TIME
• Increase Registration counter for dealing max
patients
• dispaly tracking board for alligning patient
schedule
• Application for online appointment
• Calling sequence should be automated via
treatment reminders
• Registration form should be simplify
• Dentist requested to be on time so that
patients can’t feel inconvenient.
• Skilled manpower with dentist
• Enhancement in space utilization via addition
of chairs
 CONTROL
COUNTERMEASURE TAKEN FOR REDUCING
WAITING TIME
• Control phase is the last step in the DMAIC
method. This phase is about sustaining the
changes made in the Improve phase to
guarantee lasting results. The best controls
are MONITORING, appropriate CHECKS
and balance the quality system for the long
run.

• Significant reduction in waiting time can be

achieved in the outpatient services of the dental
clinic . Dentist were on time in OPD to reduce
the delay in the OPD. Patients were
STANDARD WAITING
coordinated well to the admin staff. Further data
TIME 20 MIN
analysis will help to monitor and control the
waiting time and process flow in the OPD.

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