When you’re used to doing things “the way we’ve always done it,” it’s hard to see the flaws. Speaking of the sterilization area of a dental practice alone, the way things have always been done might be causing more bottlenecks than you ever realized. During my travels implementing principles to improve ergonomics, processing dental instruments is one of the biggies. And these bottlenecks always cost the practice time and money. 

Take a look at this photo….

How many directions does this streamline flow? Too many!

This scene is common in my line of work. It is my job to assess the processes in your dental practice and discover inefficiencies. In fact, Sterilization is one of the “Big 3” bottlenecks that exist in a dental practice (we’ll talk about the other two next week). If you run out of instruments or if you have staff working through lunch and staying late due to a backlog in dirty instruments, then you have a big bottleneck. It’s easy when the practice is slow because there is time to process instruments - inefficiently. But who wants to rely on cancellations? It doesn’t have to be this way. Let’s look at three ways you can improve your sterilization process.

1. Rate Limiting Factor

By implementing a lean culture in your dental practice, a lean transformation takes place. What do I mean? Eliminate waste. It is possible to improve a process without hiring more people, without purchasing additional equipment, without taking up more space while still providing an uncompromising level of care (1). How? Have you ever heard the phrase, ‘hurry up and wait’?  Often, I see practices attempt to speed up a particular process to make clinical run faster. But ANY process (for instance, sterilization) will only move as fast as its slowest step. I.e. This is the rate limiting factor. In sterilization, the rate limiting factor is the autoclave. No matter how much I want or NEED to speed up this step, I can’t. Your large capacity autoclave must run for 40 minutes in order to achieve sterilization. Then, the “we run out of instruments syndrome” occurs. Many dentists attempt to remedy running out of hand pieces by purchasing a high dollar piece of equipment like SciCan’s Statim. While it does process instruments in less time, it is too small. And now you’ve now broken a Lean Transformation rule by purchasing something else that takes up more space before addressing the process as a whole.  By the way, I love the Statim. But, its implementation alone is not the answer to running out of instruments problem.   

2. One Piece Flow or Single Piece Flow - Your Instruments in 4 Steps

One piece flow is all about reducing the average number of items in the system.  Take a typical hygiene procedure; in our dental practices, the standard set-up includes 9 instruments. Handling loose instruments is insane! Think about it. If instruments are securely locked in a cassette, in a standard order, then the cassette, full of instruments, is transported through a constant progression of continuous flow. So, instead of handling 9 instruments through a (sterilization) process, you handle one instrument, the cassette (full of 9 instruments). Make sense?

Instruments must be free of debris before entering the autoclave.  How you achieve this is up to you and your state’s REQUIREMENTS. You will wipe bulk debris chairside before closing cassette.  Instruments are placed in their designated slot and cassette is closed. Once you close your cassette chairside, you would never need to open it again until it is sterile and ready for use. Whether your sterilization process flows clockwise or counter-clockwise, the system must maintain forward progress.

Now that we’ve determined our rate limiting step in sterilization and embraced one piece flow, the process to achieve sterilization is simplified in four steps.

• 1. Presoak Instruments to loosen and dissolve organic debris
  (10 minutes)

This is done by filling one side of a large capacity sink ½ full of enzymatic solution and water.  Cassettes are placed in the sink.  

• 2. Power wash instruments to remove accretions
  (3.5 minutes)

What was once a manual process is now automated.  After the soak, cassettes are placed into a power washer (DIRH/Kromo DS50 Washer) to wash away debris loosened by enzyme soak.

• 3. Bag or wrap cassettes if desired
  (again, your state calls the shots) (5 minutes)

Remove cassette from washer and dress accordingly. 

• 4. Autoclave
  (40 minutes- our only rate limiting step)

3. Make It Simple

Make the systems in your practice so simple that anyone can do it. Remember the first sentence, “when you’re used to doing things the way ‘the way we’ve always done it, it’s hard to see the flaws.” Sometimes, an outside perspective can really, really help. Let us take a look! Reboot Practice Productivity Solutions is an onsite comprehensive clinical training workshop where we address critical processes in your clinical department just like this -  though sterilization is just one component. We are experts in lean manufacturing principles and we guarantee to show you how to apply these principles in your dental practice.  

We study, practice, and successfully implement these exact systems in thousands of dental practices. Call us. It’s that simple!  

Please share your feedback, questions or comments in the “New Comments” section below.  

1. Karim A, Arif-Uz-Zaman K. A methodology for effective implementation of lean strategies and its performance evaluation in manufacturing organizations.  Business Process Management Journal. 2013; 19(1): 169-196