Presented by Dr. James S. Eaves, DDS, FAGD Kathleen Eaves, PMP, CMQ/OE, CQA March 10, 2010 PMIWDC, Fairview Park © James S. Eaves 2010

 Introduction  Brief discussion of the dentistry of creating a crown  Fitting a crown and project management together  Using the crown and project management to manage programmatic quality  So what can you do with this information? (c) James S. Eaves 2010

 Creating a dental crown for a patient is a complex project.  It is a project under the PMI definition – an activity with a unique product and result.  It is also a project that is part of the overall program of providing dental care to patients.  Data from each crown project can be used as input into a quality management system for the program. (c) James S. Eaves 2010

A dental crown only seems this expensive.

 A crown is a restoration that covers, or "caps," a tooth to restore it to its normal shape and size, strengthening and improving the appearance of a tooth.  Academy of General Dentistry website: le/?abc=C&iid=301&aid= le/?abc=C&iid=301&aid=1204 (c) James S. Eaves 2010

 To prepare the tooth for a crown, the dentist reduces the tooth so the crown can fit over it.  An impression of the teeth and gums is made and sent to the lab for the crown fabrication.  A temporary crown is fitted over the tooth until the permanent crown is made. © James S. Eaves 2010

 On the next visit, the dentist removes the temporary crown and cements the permanent crown onto the tooth.

© James S. Eaves 2010

 Project charters are informal and result from diagnosis by the dentist and consultation with the patient.  Informed consent is required and forms the basis of the “project charter”.  Due to biological constraints, some variables cannot be controlled, but can be monitored and adjustments made.  The project closes when the crown is cemented and both the patient and the dentist agree that all requirements are met. © James S. Eaves 2010

 Scope determination is a cooperative agreement with the patient and dentist.  Scope for a crown will include specifications for material and color, and any preliminary work needed on the tooth (root canal, gum surgery).  Additional dental work may be necessary to ensure success of the crown. Example: replacing an old filling in the next tooth.  Changes in scope may occur during the project due to the discovery of unexpected conditions internal to the tooth. Careful monitoring is required. © James S. Eaves 2010

(c) James S. Eaves 2010

 All professionals (lawyers, doctors, accountants, etc.) charge for their time and expertise. Time management is critical.  Historical data allows for nearly precise scheduling of the procedures.  Patient time is a resource that also has to be scheduled. © James S. Eaves 2010

 When the schedule is known, the costs can be determined.  Fixed overhead  Labor costs  Materials  Laboratory costs  Efficient use of time and skilled labor can dramatically decrease the cost of a crown.  The most effective cost management is quality management. The crown project will overrun its budget if the crown doesn’t fit and must be remade. © James S. Eaves 2010

 Dentists are taught how to do things “the right way” but are not taught quality concepts.  An office quality program can include:  procedural protocols  measuring success and failure rates  determining corrective action and  surveying patients.  A dentist may have quality standards for the suppliers (laboratory and specialists). For example, if a crown can’t be made to fit in 10 minutes, it is remade. © James S. Eaves 2010

 In dentistry, everything is about the people.  The customer is part of the team. We can’t do a crown if there is no patient.  The project team consists of my staff and the patient. However, scheduling may require the efforts of many more people.  Dental assistants are essential members of the team. Their training, skills and work ethic lead to success in managing time, communication, and quality.  Providing hundreds of crowns per year allows us to accurately plan and schedule human resources. © James S. Eaves 2010

 In a health care setting, communications is everything.  Formal communications such as informed consent are required.  Communications for a crown begins with the explaining the initial diagnosis to the patient. Other stakeholders include third party payers and the staff. All communications are regulated by HIPAA for providers using any form of electronic communications. © James S. Eaves 2010

(c) James S. Eaves 2010

 The primary risks in a crown project are:  The tooth does not need a crown.  The tooth requires more than a crown.  The tooth is not restorable.  The patient has an underlying condition that caused the need for the crown.  The crown doesn’t fit.  Some of these risks require a mitigation plan that may include not crowning the tooth. © James S. Eaves 2010

 Because creating a crown is a micro-project that is done with established processes, very little is necessary to plan acquisitions.  Materials are from ISO900x registered companies.  Laboratories have Certified Dental Technician (CDT) staff.  Inventory is controlled according to protocols. The protocols are developed using historical data from many crowns over many years. © James S. Eaves 2010

(c) James S. Eaves 2010

 Each project (crown) can be considered to be part of a program of providing patient care in a dental office.  Quality systems are built on a programmatic level, not a project level. (c) James S. Eaves 2010

 Quality improvement is based on tracking repeatable processes that yield measureable results.  In a small project, there are not very many steps that yield a measureable result.  Data from multiple projects that use the same procedures and suppliers can be combined into a larger picture of quality.  This data can be used to modify the process of creating a crown or may influence the choice of suppliers. © James S. Eaves 2010

(c) James S. Eaves 2010

 Ensure processes are in control – no systematic errors are creeping in.  Better control of costs, time, and resources.  Allow time and money to be spent on other improvements. © James S. Eaves 2010

(c) James S. Eaves 2010

 Look at your own small projects.  Are there other small projects that could be combined with yours to collect quality data on a supplier or procedure?  Look within and across corporate dividing lines. © James S. Eaves 2010

 Think about people in your life who could benefit from your project management knowledge, then offer to share.  Your doctor or dentist  Any large project done by a community group  Capital investments by your homeowners association  Big programs at your house of worship  A season at the community theater  Don’t assume that because someone has been doing something for a while that they manage it using project management principles. (c) James S. Eaves 2010

 Brush  Floss  See your dentist on the schedule recommended for you. (c) James S. Eaves 2010

© James S. Eaves 2010