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When your team makes mistakes, try the Reliability model for solutions

April 13, 2023
No team is perfect, so it's safe to say that mistakes will happen. The Reliability model offers dental teams a framework for identifying problems' root cause.

Of course, the answer to the question “Is your team perfect?” is no. None of us are perfect. We are human, and we are going to make mistakes. But what if we could create an environment where we feel safe taking accountability for those mistakes? What if when we made mistakes, we had a team that would come alongside us to determine the root cause and brainstorm solutions? What if we could eliminate recurring issues, rework, duplicative effort, and non-value-added steps to ensure a repeatable and reliable process in our dental offices?

The great news is that we have a process methodology called Reliability that will do just that!

Instead of attacking the person, Reliability allows you to attack the problem. When you make a mistake, you are far more likely to report the mistake when you know that you will not be attacked for making the mistake in the first place. You are far more likely to report a mistake when you know the team will help you determine the root cause and develop a collaborative solution to prevent the same mistake from reoccurring.

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Reliability is a process methodology and mindset that allows teams to:

  • Identify and triage problems
  • Determine root cause and define solutions
  • Implement and monitor preventative measures

Identifying and triaging problems

The first phase of Reliability documents via automation, or a simple spreadsheet, these four key questions:

  1. What happened?
  2. What is the impact?
  3. Who is responsible for resolving the problem?
  4. What is the timeline for resolving the problem?

Once you have the answers to these questions, you can create a problem statement, determine the root cause, define a solution, and assign a resolution timeline. Keep in mind that the person who identifies the problem or makes the mistake may not be the same person who develops the solution or implements the preventative measure. It is perfectly acceptable to make changes/updates to questions three and four as you progress through the Reliability process.

Determining the root cause and defining possible solutions

The second phase of Reliability is to determine the root cause and define solutions. When determining the root cause of a problem, there is one three-letter word that can cause great consternation with your team if you use it in the wrong way or in the wrong context.

This word is why.

When you make a mistake, which statement would you rather hear?

  1. Why did you do that?
  2. Why did that happen?

Statement number one places blame on the person. Number two starts to examine the root cause of the problem. I promise that our teams prefer to hear question number two. Notice the four key questions in the triage phase. These questions do not ask who made the mistake. The questions simply state the problem. If the why word is used, it needs to attack the problem and not the person.

A great root cause analysis tool that does not place blame on the person is the “5 Whys.”

The 5 Whys asks, five times, why a situation has occurred. Asking “why” five times will usually get to the root cause of a problem statement. Keep in mind that not all problems require asking why five times. Some problems may only require asking why two or three times. Failure to determine the root cause of the problem will only treat the symptoms. If you only treat the symptoms of the problem, I guarantee it will return. 

Below is a classic 5 Whys example related to the Washington Monument:

Problem statement: The Washington Monument’s base is disintegrating!
  1. Why is the base disintegrating? Because harsh chemicals are being used.
  2. Why are harsh chemicals being used? To clean the pigeon poop.
  3. Why is there so much pigeon poop? Pigeons eat spiders, and there are a ton of spiders at the base of the Monument.
  4. Why are there a ton of spiders? Spiders eat gnats, and there are a ton of gnats at the base of the Monument.
  5. Why are there so many gnats? The gnats are attracted to the light at dusk. 
Solution: Turn on the lights later, after dusk 

Once the root cause has been identified, then the team can brainstorm and agree upon a solution. There can be multiple solutions for the same problem, so how do you know the solution you defined is working? What if you chose the wrong solution? How would you know the solution was wrong?

Implementing and monitoring preventative measures

The third and final phase of Reliability is to implement and monitor the preventative measure.

A reliable and repeatable process must implement and monitor preventative measures to ensure the chosen solution is working. If the same mistakes are made in the future and logged during triage, then you know that the original solution needs to be reworked. 

Examples of preventative measures can be systemic automation, process checklist, version control logs, etc. A great example of a preventative measure in the Washington Monument illustration is an automatic timer that can be adjusted for Daylight Savings Time. The park staff will then monitor the base of the Washington Monument on a regular interval to ensure the base is no longer deteriorating since turning on the lights later.

While coaching a team member is important, coaching, in and of itself, is not a preventative measure. What if you have two dental offices miles apart, and the same mistake is happening in both locations? Coaching one team member and saying, “don’t do that,” is not enough. You need a true preventative measure like automation or a checklist to prevent the entire team from making the same mistake in the future.

Applying Reliability methodology in a dental office

Every problem that occurs in our dental office follows the Reliability Process Methodology model. When a mistake is made, the problem goes on the log, answering the four triage questions, the root cause is determined, solutions are brainstormed, and preventative measures are put in place.

Identify and triage the problem:

  • What Happened? Critical information was omitted during the new patient intake phone call.
  • What is the Impact? The new patient loses confidence that we are actively listening when we have to make multiple phone calls to them because we forgot to ask for all of the information on the original call.
  • Who is responsible for the resolution? The patient intake coordinator.
  • What is the timing for resolution? Immediate—within 15-30 minutes.

Determine root cause and define solutions:

Problem statement: It is difficult to gather all required new patient information with the patient on the phone.Root cause why analysis:
  • Why is it difficult to gather all required new patient information with the patient on the phone? Because the practice management software is not streamlined for new patient intake.
  • Why is the practice management software not streamlined for new patient intake? Because multiple modules allow you to move from module to module without completing all required fields before moving to the next module.
  • Why are there multiple modules that allow you to move from module to module without completing all required fields? Because of a system data flaw.
  • Define solutions:
    • Submit streamlined new patient information to data programmers to require critical fields needed for set-up before moving to the next module.
    • While waiting on the data programmers to streamline the practice management software and to prevent multiple calls to the new patient because we forgot a piece of critical information, create a desktop checklist that can be imported to the patient chart and entered in multiple modules once the patient is off the phone.

    Implement and monitor preventive measures:

    • Preventive measure: Desktop checklist that can be referenced once the patient is no longer on the phone to ensure accuracy across the multiple new patient modules.
    • Monitor preventive measure: Monitor the Reliability log to ensure no new patient intake mistakes are made in the future. If a mistake is made for an item not on the checklist, simply add the additional information required to the desktop checklist and share the newly added item with your teams.

    So, no. Your team will never be perfect, but you can use the Reliability model to create a culture where the team attacks the problem, never the person.