Fig. 1. Type of occupational injury or illness experienced by dental hygienists with employ- ment-relatedinjuryorillness,2007.3(Chart/ProvidedbytheCenterforHealthWorkforceand AmericanDentalHygienists’Association) Fig.2.SteveKnightatLeMans.Today,asabusinessturnaroundspecialist,Knightbringslessons from racing to dentistry. His goal is to turn around the world of seating for dental hygienists andalldentalprofessionals. (Racephotos/ProvidedbySteveKnight) Fig. 3. Steve Knight at Laguna. In racing, perfect driver ergonomics is critical. Knight’s Goldi- locks theory applies to a dental practice using existing seating simply because it was already there:Sometimesit’s too tallor tooshort,andnomatterhowmuchit isadjusted,it isstillnot just right. Dental Tribune Middle East & Africa Edition | 2/2016 8 mCME Checklists not just for pilots anymore mCMEarticlesinDentalTribunehavebeenapprovedby: HAADashavingeducationalcontentfor2CMECreditHours DHAawardedthisprogramfor2CPDCreditPoints ByPattiDiGangi,RDH,BS,JudyBen- dit,RDH,BS With popularity of the television show “Mad Men,” 1960's themes such as war, racism and sexism are memorialized, as are once-common habits such as smoking. Women were marketed in the 1960s with their own cigarette brand that had the catch phrase, “You’ve come a long way, baby.” Following release of Smoking and Health: Report of the Advisory Committee to the Sur- geon General of the United States,1 all smoking-related advertising was bannedfromTVin1970.2 Sit-down dentistry also evolved in the 1960's. “You’ve come a long way, baby” is gone from advertising, but it remains an accurate slogan when it comes to ergonomics in dentistry. We have come a long way, but for many dental professionals, that’s stillnotfarenough. In 1937, pilots developed the concept of the checklist after planes began crashing. Dental professionals may not be crashing in the literal sense, but many clinicians have been forced into early retirement because of musculoskeletal disorders (MSD) or they continue to try to work through them. By incorporating a checklistconceptsimilartothatused by pilots, dental professionals can be more successful, productive — and abletopracticewithoutpain. Painindentistry Pain of dentistry is a common fear that keeps patients away from the dental office. Pain in dentistry is common,buthasnothingtodowith the patient. The individuals having pain in dentistry are the practition- ers. It is estimated that more than half of practitioners have some kind of painful musculoskeletal disorder thatisworkrelated.3 In 2007, the Center for Health Workforce, funded by the Ameri- can Dental Hygienists’ Association (ADHA), conducted a sample survey of licensed dental hygienists about a wide variety of issues, including oc- cupationalinjuryorillnessrelatedto their work. It was reported that just more than one-third (33.8 percent) indicated had experienced an oc- cupational injury or illness. Figure 1 shows the types and percentages of occupational injury or illness expe- rienced. More than half (53 percent) used medication to control the dis- comfort and nearly half (49.5 per- cent) indicated they had shortened their work hours as a result of their injuryorillness.4 Ergonomics evolved as a recognized field during World War II. It is the science of adjusting the work envi- ronmenttotheworker.5 TheOccupa- tionalSafetyandHealthAdministra- tion (OSHA) has links to ergonomic information.6 The American Dental Association (ADA) published Intro- duction to Ergonomics7 with sug- gested interventions and in 2011 published Ergonomics for Dental Students.8 The ADA website has an ergonomics section with links to fli- ers about specific problems.9 Even with numerous articles and C.E. courses (both in person and online) onergonomicsinthefiveyearssince the ADHA survey, MSDs continue to escalate. Much of this is because of a hand-me-down mentality in many dentaloffices. 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-operator seating, just one of the many parts creating a healthy ergonomicenvironment. Checklistshelpfindtheway In the days of early aviation, pilots were crashing because they could not reach the controls. Investigators found it was pilot error as the cause. Pilot error doesn’t necessarily mean thepilotdidsomethingwrong;itcan mean the pilot wasn’t familiar with the equipment or the equipment didn’tmatchthepilot.Forthosewho workinatemporarydentalsituation at multiple offices, ergonomic chal- lenges are huge. When such practi- tioners walk into a new office, trying to match their individual needs to the available equipment is nearly impossible. Pilot checklists were developed to match the steps needed for the job, making sure that everything is done and nothing is overlooked. Check- lists have become fundamental to the aviation industry.10 In a similar way, checklists should become fun- damentaltothedentalindustry. Two books, “The Checklist Manifes- to: 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 medi- cal 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 common in some hospital settings, but not nearly common enough. It takes a change of culture to adopt something that on the surface can seem so simple — as a core strategy forenhancingcare. 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 delivery and one of the most complex and expensive. 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 makepatientcaresaferinmorethan 100 ICUs in Michigan. The project targeted the expensive and poten- tially lethal catheter-related blood- stream infections that cost $18,000 when a patient contracts one and causes 24,000 deaths per year. The Keystone team made a checklist, measured infection rates — and changed hospital culture. There was a 66 percent reduction in this type of infection statewide, saving more than 1,500 lives and $200 million in the first 18 months of the program.14 It was the combination of checklists and the culture of teamwork that madethedifference. Race car drivers and race cars take quite a beating during a race, both physically and mechanically. Like pi- lots, race car drivers and their teams use checklists. The teamwork of a pit crewduringaraceisartistrytowatch that is fostered by checklists. Steve Knight, once a professional Le Mans racecardriver(Figs.2and3)andbusi- nessturnaroundspecialist,hastaken lessons from racing and brought them to dentistry. His goal is to turn around the world of seating for den- tal hygienists and all dental profes- sionals. Seatingriskfactorchecklist Before Knight got into a Le Mans car there were many considerations to be addressed. An impression of the driver’s body is taken to ensure a perfect fit into the seat of the car for optimal performance. This molding created: proper leg-stretch to reach the clutch, accelerator and brake; comfort in reaching and holding the steering wheel; and most important, the ability to sit comfortably for long periods of time while driving around the race course. Success for a top-level race car driver is driven by a strict regimen for eating, exercise andnearlyallactivitiesofdailylifeso they can be in top shape physically. It is the total package, including the racing team and pit crew all using checklists,thatcreatesthissuccess. The idea of a form-fitting chair for dental practitioners might not be practical, yet think of the possibili- ties.Thosesameideascanbebrought into the treatment rooms with the “Seating Risk Assessment Checklist” shown in Table 1. This checklist helps to evaluate overall balance. Many professionals have damaged them- selves by repeatedly sitting, leaning, stretching and twisting for so many years. As Cindy Purdy, RDH, BS, con- sulting with Crown Seating recently said to an online group, “Changing stools alone will not treat medical issues, but it can certainly offer ben- efitsforthefuture.”15 Recline/inclineseating Passengersarerequiredtositupright at take-off and landing on any plane (Fig. 4). Most passengers can’t wait to hear the announcement that the cruising altitude has been reached so the seats can be leaned back for morecomfort.Unfortunately,dental professionals tend to sit in this up- right position all day. When seated in this position for long periods of time, practitioners both elongate andshortendifferentmusclegroups inthelegs.Humansarenotmeantto sitcompletelyuprightandespecially notforalongdayintheoffice.16 A more comfortable sitting position for most is in a reclined position (Fig. 5). Think of your comfortable re- cliner in front of the television after a long day of work or the experience sitting in a first-class seat on a plane. Recliningissoverycomfortable.This is the way race car drivers sit; but it’s not very practical for treating dental patients. Now take that reclined position and rotate the torso on its axis to create the inverse position, called an in- clined position17 (Fig 6). Incline is the automatic position created when sitting on a horse or a saddle stool. It is a more balanced position. This balance helps preserve the hips and spine in the proper position. It is de- fined as an open body position that is more comfortable, less harmful and allows for proper lumbar cur- ÿPage9 CAPP designates this activity for 2 CE Credits.