Improving Dental Service via Communication During Treatment

1. Improving Dental Service via Communication During Treatment Philwoong Kang – Junhong Kim Hyoyoung Kim – James Morrison Industrial and Systems Engineering ICSSSM’11 – June 25-27, 2011 – Tianjin, China

2. Contents • Motivation • Objectives • Handheld communication device prototype • Experiment to test the device effectiveness • Results • Concluding Remarks

3. Who enjoys going to the dentist?!

4. I do… !

5. Because, I found … Kenneth Palm, DDS

6. Kenneth Palm, DDS Quotes1 from his patients: 1 http://www.colchesterdental.com/smile_gallery/

7. Kenneth Palm, DDS Quotes1 from his patients: “This is the only dentist office I ever enjoyed coming to!” 1 http://www.colchesterdental.com/smile_gallery/

8. Kenneth Palm, DDS Quotes1 from his patients: “This is the only dentist office I ever enjoyed coming to!” “Dr. Palm and his staff are absolutely wonderful people!” 1 http://www.colchesterdental.com/smile_gallery/

9. Kenneth Palm, DDS Quotes1 from his patients: “This is the only dentist office I ever enjoyed coming to!” “Dr. Palm and his staff are absolutely wonderful people!” “The best dentist… EVER!” 1 http://www.colchesterdental.com/smile_gallery/

10. Kenneth Palm, DDS Quotes1 from his patients: “This is the only dentist office I ever enjoyed coming to!” “Dr. Palm and his staff are absolutely wonderful people!” “The best dentist… EVER!” – I just added that one from me 1 http://www.colchesterdental.com/smile_gallery/

11. Why do people like Dr. Palm? Kenneth Palm, DDS

12. Why do people like Dr. Palm? Kenneth Palm, DDS I honestly do not know if his technical skills are better than others. I suppose they may be…

13. Why do people like Dr. Palm? Kenneth Palm, DDS But, his communicationskills– humor, caring, clarity – are truly extraordinary!

14. Motivation (1) • How important is communication to most patients? • Survey to assess the perceived value of communication • Ability of dentist primarily depends on communication [1] 76% of patients consider communication the most important factor [1]A review of patient satisfaction: 2.Dental patient satisfaction: an appraisal of recent literature, P.R.H. Newsome G.H.Wright, 1999

15. Motivation (2) • Is there a “low hanging fruit” communication opportunity? • Surveyed dental patients to ask about ease of communication Express difficulty to communicate during treatment 1 = Very hard to communicate 5= Very easy to communicate

16. Research Objectives • PROBLEM: • Patients feel it is difficult to communicate during treatment • No communication device existing • No device to solve this problem was found in the literature • GOAL: • Create a hand-held device to aid communication during treatment • Measure how much the service quality at dental clinics improves

17. Prototype Design: Methodology • Prototype designed with the Axiomatic Design methodology • Concept: Handheld device with buttons to communicate

18. Prototype Design: Buttons • Four buttons use to receive the input from the patient • Selected the most commonly desired: Survey & discussion with dentists • Button shape and feeling chosen for intuitive feeling • Button location based on frequency of use (thumb is most favored digit) • BUTTON 1: Patient is in pain • BUTTON 2: Patient would like suction of fluids • BUTTON 3: Patient wants to pause/stop the treatment • BUTTON 4: Patient want to express thanks or “enough” [2] [2] http://myworld.ebay.com/protherapysuppliesllc

19. Prototype Design: Considerations from the Literature • Data from mouse, remote control, keyboard was used to determine: size, tactual feedback, sensitivity, weight etc.[1] • Hand data of Koreans, US army, and Jordanians were used when designing the prototype Average length of wrist to finger for US army and Korean[3] Right hand dimension data of Jordanian[2] [1] Donghun Lee, Min K. Chung, Jung Young Kim. An Investigation of Using Practices for Universal Design of Information Technology Products. Journal of the Ergonomics Society of Korea Vol. 28, No. 3 [2] Yunis A.A. Mohammad. Anthropometric characteristics of the hand based on laterality and sex among Jordanian. International Journal of Industrial Ergonomics 35 (2005) 747–754 [3] Wonsup Lee, Kiyo Jung, Heecheon You. Development and Application of a Grip Design Method using Hand Anthropometric Data. 2008 Korea Industrial Engineering Conference / KORMS

20. Prototype Design: CAD Models • Three prototype designs • Selected the bean-pod model (middle) • Light and fits comfortably into hand • Design was drawn with SolidWorks 2010® • Prototype shell was made with a Rapid Prototype Machine Input device prototype designs Bean-pod input device shell

21. Prototype Design: Sound Options • Microprocessor: Detects button push and emits audio signal • Wireless earphones emit a sound in response to the signals • Three categories of sound outputs were recorded • Equipment details • Two sets of Kimson® KS-1040S Bluetooth Wireless Headset and Hands-Free were used • Wireless headsets are connected to the mp3 microprocessor board with the iBluon BT-TD03 stereo Bluetooth Dongle

22. Experiment to Test Device Effectiveness (1) • GOAL: Determine if the device improves dental service • METHOD: Experiment from 2010/11/30 – 2010/12/09 • Patient control group did not use the device during their treatment • Modified SERVQUAL surveys given before and after treatment • Patient experimental group did use the device during their treatment • Modified SERVQUAL surveys given before and after treatment • Data recorder sat in the procedure room during the treatment • Additional questions about the feel and use of the device • Input device was wiped with sanitizing tissue after every use

23. Experiment to Test Device Effectiveness (2) • Conducted in dental offices in Daejeon, South Korea • Population: 88 without, 87 with the device • Modified SERVQUAL survey consisted of • 21 SERVQUAL questions, 4 overall quality questions and demographics • Expectation and perception questions • 5 point Likert scale: • Statistical hypotesis tests conducted • Wilcoxon [1] signed-rank test (paired sample test) in SAS 9.1 • Alternative to paired patients t-test since distribution is not normal 2 5 1 3 4 Not important at all Very important [1] Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics, 1, 80-83

24. SERVQUAL Survey sheet Tangible Reliability Responsiveness Assurance Empathy

25. Results: SERVQUAL • Gap score = Perception score - Expectation score

26. Results: SERVQUAL Dimensions • H0: no difference in measurements • H1: difference in measurements • Using 0.05 level of significance, if z> 1.96 or z<-1.96, H0 is rejected Unweighted SERVQUAL average gap score for each dimension

27. Results: Overall Questions Average score for overall question

28. Concluding Remarks • SERVQUAL results of statistical significance • Increase in “quick response from dentist” (Responsiveness dimension) • Increase in “communicate at lot” (Empathy dimension) • Overall results of statistical significance • Increase in “communication during treatment” • Not significant: Overall service, kindness and treatment result • In part due to device training, presence of data recorder, longer survey • Anticipate that a communication device during treatment will improve overall dental customer experience

29. Thank You.Any Questions? Please visit us on the web at http://xS3D.kaist.edu

30. Appendix [Table 8] Hypothesis Testing for all questionnaire

31. Appendix [Figure 9] Hypothesis testing

32. Appendix [Figure 9] Hypothesis testing