hygiene - the international C.E. magazine of dental hygiene

I 11hygiene 1_2012 C.E. article_ ergonomics I continue to escalate. Much of this is because of a hand-me-down mentality in many dental offices. For the safest flight, pilots use many checklists. In dentistry, a one-size-fits-all checklist is not enough to evaluate how we do things because of the wide variety of body types, shapes and preferred work styles. This article will develop checklists for dental- operatorseating,justoneofthemanypartscreating a healthy ergonomic environment. _Checklists help find the way In the days of early aviation, pilots were crashing becausetheycouldnotreachthecontrols.Investiga- tors found it was pilot error as the cause. Pilot error doesn’t necessarily mean the pilot did something wrong;itcanmeanthepilotwasn’tfamiliarwiththe equipment or the equipment didn’t match the pilot. For those who work in a temporary dental situation at multiple offices, ergonomic challenges are huge. When such practitioners walk into a new office, try- ing to match their individual needs to the available equipment is nearly impossible. Pilotchecklistsweredevelopedtomatchthesteps needed for the job, making sure that everything is done and nothing is overlooked. Checklists have become fundamental to the aviation industry.10 In a similar way, checklists should become fundamental to the dental industry. Two books, “The Checklist Manifesto: How to Get Things Right”11 by Dr. Atul Gawande, a surgeon, and “Safe Patients, Smart Hospitals”12 by Dr. Peter Pronovost, discuss checklists as an effective way to reduce medical errors. These books are not just about the checklists, they are about the culture of medicine and how the checklist can foster better teamwork. Checklists are starting to become com- mon in some hospital settings, but not nearly com- mon enough. It takes a change of culture to adopt something that on the surface can seem so simple — as a core strategy for enhancing care. A recent success story illustrates the difference checklists can make in medicine. The intensive care unit (ICU) at a hospital is a crucial part of health care deliveryandoneofthemostcomplexandexpensive. The Centers for Disease Control (CDC) reported that nearly every patient admitted to an ICU experiences some type of complication during his or her stay.13 Checklists were used in the Michigan Keystone Project to make patient care safer in more than 100 ICUs in Michigan. The project targeted the expensive and potentially lethal catheter-related bloodstream infections that cost $18,000 when a patient con- tracts one and causes 24,000 deaths per year. The Keystone team made a checklist, measured infection rates—andchangedhospitalculture.Therewasa66 percentreductioninthistypeofinfectionstatewide, saving more than 1,500 lives and $200 million in the first18monthsoftheprogram.14 Itwasthecombina- tion of checklists and the culture of teamwork that made the difference. Racecardriversandracecarstakequiteabeating during a race, both physically and mechanically. Like pilots,racecardriversandtheirteamsusechecklists. The teamwork of a pit crew during a race is artistry to watch that is fostered by checklists. Steve Knight, once a professional Le Mans race car driver (Figs. 2 and 3) and business turnaround specialist, has taken lessons from racing and brought them to dentistry. His goal is to turn around the world of seating for dental hygienists and all dental professionals. _Seating risk factor checklist Before Knight got into a Le Mans car there were many considerations to be addressed. An impres- sion of the driver’s body is taken to ensure a perfect fit into the seat of the car for optimal performance. Thismoldingcreated:properleg-stretchtoreachthe clutch, accelerator and brake; comfort in reaching andholdingthesteeringwheel;andmostimportant, the ability to sit comfortably for long periods of time Fig. 2_Steve Knight at LeMans. Today, as a business turnaround specialist, Knight brings lessons from racing to dentistry. His goal is to turn around the world of seating for dental hygienists and all dental professionals. (Race photos/ Provided by Steve Knight) Fig. 3_Steve Knight at Laguna. In racing, perfect driver ergonomics is critical. Knight’s Goldilocks theory applies to a dental practice using existing seating simply because it was already there: Sometimes it’s too tall or too short, and no matter how much it is adjusted, it is still not just right. Fig. 2 Fig. 3