Office Organization Systems

Enhance Practice Efficiency and Patient Experience

Kari Lance, LDA; Erin Reil, LDA; Jeffrey Norsted, DDS

Although organization is not a natural strength for everyone, this management skill is critical in a healthcare environment. Outside influences such as regulatory compliance, environmental issues, economic factors, and incorporation of new technology all provide good reason for dental practices to commit to office organization. Long-term benefits include increased efficiency, effectiveness, productivity, and enhanced communication. Having no specified systems in place can produce higher stress levels in the workplace. From the front office to the clinical areas, the entire dental team—along with the patients—benefits when the practice runs smoothly.

When there is no organization system—for example, when unidentified bags of instruments are placed in drawers or cupboards after sterilization—the dental assistant must search through the bags to determine the correct package for the next procedure. Materials may be stored in each treatment room in drawers or cupboards (Figure 1).

Components of an Organizational System

There are two basic styles of organization commonly used for dental instruments, materials, and supplies:

• Tub and tray system—instruments in sterilization bags with instrument holders that are color-coded by procedure and purpose. Materials are stored in tubs color-coded to align with instrument holders by procedure and purpose.
• Cassette system—instruments are color-coded and arranged in procedural order in cassettes. Materials are stored in tubs color-coded to coordinating cassettes, similar to the tray system.

Dental practices employ either the tray or cassette system, based on their particular needs. Components of both of these systems include:

• Tubs: containers that hold support materials for procedures. For example, composite material, etchant, syringe tips, shade guides, and clear matrix for a composite procedure; or endo files and reamers, paper points, gutta percha, and apex locator for a root canal procedure. Tubs eliminate the need to open drawers and doors during a procedure. (Figure 2)
• Lids: clear covers that protect and secure everything inside a tub, but allow for full view at a glance.
• Organizers/inserts: dividers that hold supporting materials in place, keeping the contents of the tub neat.
• Mats: hold instruments stable and in appropriate order for procedure, especially with the tray system. Their use minimizes the noise of metal instruments against hard surfaces (Figure 3).
• Bur blocks: magnetic holders to organize tiny, sharp rotary instruments.
• Storage racks: allow for stacking of trays and tubs in the order of the day’s scheduled procedures (Figure 4).
• Instrument rings: fit snugly on instruments to allow quick visual identification of specific procedures, individuals, treatment rooms, or sequence of use during a procedure (ie, one ring = first instrument used; two rings = second instrument used).
• Mini-cassettes/stericages: for practices using tray systems, these holders keep contaminated instruments together for transport to the sterilization area and can be placed directly into an ultrasonic system and autoclave (Figure 5, Figure 6 and Figure 7).
• Cassettes: instruments are placed in slots in order of use, and the cassette is sterilized. When the cassette is opened, the contents are ready for use and in the appropriate order.

Outside Influences Promoting Organization

Developing and maintaining organizational efficiency in a dental practice is a practical, cost-effective response to address regulatory compliance, environmental issues, economic factors, and the space limitations in the office.

The 2008 Centers for Disease Control (CDC) recommendations state that contaminated instruments should be secured in a rigid container when being transported. In additional, team members should not reach into ultrasonic cleaners to remove individual instruments.¹

Organization efficiencies reduce product waste and disposables (which is beneficial for the environment, as well as the practice). Given the current economic environment, most professions are required to figure out how to be more efficient—how to produce more work and more procedures in less time with fewer economic resources.

As dental practices incorporate new technologies into their offices, they need to create space in which to locate this equipment, thus leaving less area for storage of other supplies and materials.

Benefits to Organization

Patients perceive organization and its results. For some patients, the experience of visiting the dentist can be a source of anxiety, and the professionalism that organization conveys can help reduce this stress. The appearance of the dental operatory can affect a patient’s experience significantly. An operatory that is clutter-free and coordinated will be more appealing to patients.

No two coworkers in the dental office need teamwork and cooperation more than the dentist and assistant as they treat their patients together. How organized a dentist and assistant are in performing their clinical duties can either enhance or diminish a patient’s dental experience. If the dental assistant needs to leave the operatory mid-procedure to get something, the appointment flow is delayed and patient focus is interrupted. When the team works well together in an organized and efficient manner, it contributes to a calm and relaxed atmosphere.

While office organization provides several benefits for patients, it can also serve to have a positive effect on the entire dental team. A system that is understood and maintained definitely saves time and effort during the day. For example, dental assistants can appreciate how a color-coded tub and tray system allows them to customize a specific color tub and tray to a particular dental procedure. By having one tub to retrieve quickly and bring into an operatory (versus pulling materials from multiple drawers and locations), efficiency is increased. It also reduces the possibility of running out of a supply and having to leave the room during a procedure.

A color-coded tub and tray system also simplifies supply stocking and ordering for the assistant. Instead of multiple supplies in different operatories, there is only one centralized area to stock, thus reducing the amount of inventory necessary to have on hand. It is also much faster to identify supply inventory needs when they are centrally located.

Dentists benefit from the simplicity of the color-coded organization system. For example, if it is necessary to treat a patient on an emergency basis after hours, the color-coded tubs and trays will eliminate time spent searching for instruments and materials. Instead, everything the dentist needs is readily available in a designated tub and tray. The practice may even designate an afterhour’s emergency tub with several commonly used emergency materials in one convenient location.

To facilitate organization for morning and afternoon, all trays for the next session can be prepared in the sterile tray rack, ready to “grab ‘n go.” This allows the option to leave bagging and sterilizing procedures to the end of the session if time is limited.

The concept of color-coded trays and tubs illustrates how much a simple organization system can accomplish. When a dental operatory is clutter-free and organized, the doctor and assistant will be able to function more efficiently as a team. When disorder and confusion is avoided, people will likely be more efficient, and more satisfied with the workplace. When the team operates in an effective manner, a major benefit is increased productivity.

A dentist and assistant utilizing the appropriate organizational systems can create a positive ripple effect throughout the entire office. The dentist will appreciate an uncluttered operatory in which to treat patients, and having all the supplies immediately accessible is calming to the patient and the team. Dental assistants will appreciate the stress reduction that good organization provides, allowing them more time to devote to their patient communication. When a dentist and assistant perform efficiently, they are more likely to adhere to their scheduled appointment times, thus helping the business staff plan schedules accurately and not have to explain delays to patients.

A System in Practice

While there are many different organizational systems available to assist dental teams, the tub and tray or cassette systems along with color-coding is an easy, almost immediate way to benefit patients and staff. As virtually every component of every procedure has a color “ID,” an operator can set up and tear down quickly and efficiently. In a time crunch, other team members can easily step in and help with room turn over and sterilization procedures.

In December 2010, this dental practice implemented a tub and tray organization system (Figure 8, Figure 9, Figure 10 and Figure 11). After the needs were calculated, colors were chosen and the components acquired. Materials were removed from the operatory drawers and organized in tubs and a central stocking and sterilization area. Color-coded rings were placed on instruments for procedures corresponding to their matching tubs and trays.

Crown and bridge, composite, and endodontic procedures were specifically monitored for changes. The following outcomes were reported by the Licensed Dental Assistant monitoring the process:

• Reduced set up times (averaging 15 to 20 minutes per procedure)
• Procedure appointment lengths were reduced
• Patients required shorter appointments
• More patients were seen
• Reduction in stocking time
• System was easy to learn and use

Additional comments from staff included the notation that color coded rings saved time in sterilization, and other team members could help at a glance. The magnetized, color coded bur blocks kept small items together in the set ups, and the mats minimized movement and noise while keeping the instruments in place on the trays.

Getting Started

When evaluating organization systems, there are several aspects to consider. The first is front end and operating costs. Daily operating costs for bags, wraps, and tray covers are essentially the same and incidental to the office visit. Cassette systems may be more expensive initially, especially if the office is investing in an autoclave specifically to handle cassettes. Dental office organization suppliers, such as DUX Dental, provide an Office Organization Calculator on on their website (www.duxdental.com/calculator.aspx). Enter the numbers and types of procedures the practice performs, and the system will calculate recommended products and quantity (Figure 12).

Organization is having a system for everything. With a little planning, dental assistants can facilitate turning the workplace into a methodical system of well-orchestrated routines, always ready for the next procedure, the patient, and the next day.

References

1. Rutala WA, Weber DJ. Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities. Centers for Disease Control. 2008.