Philwoong Kang – Junhong Kim Hyoyoung Kim – James Morrison Industrial and Systems Engineering...

Philwoong Kang – Junhong Kim Hyoyoung Kim – James Morrison

Industrial and Systems Engineering

ICSSSM’11 – June 25-27, 2011 – Tianjin, China

Improving Dental Service via Communi-cation During Treatment

© P. Kang, J. Kim, H. Kim, J. Morrison – ICSSSM’11 – June 25, 2011 - 2

Contents

• Motivation

• Objectives

• Handheld communication device prototype

• Experiment to test the device effectiveness

• Results

• Concluding Remarks


Who enjoys going to the dentist?!


I do… !


Because, I found …

Kenneth Palm, DDS


Kenneth Palm, DDS

Quotes1 from his patients:

1 http://www.colchesterdental.com/smile_gallery/


Kenneth Palm, DDS

Quotes1 from his patients:“This is the only dentist office I ever enjoyed coming to!”



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!”



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!”



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



Kenneth Palm, DDS

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…


Kenneth Palm, DDS


But, his communication skills – humor, caring, clarity – are truly extraordinary!


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


Motivation (2)

• Is there a “low hanging fruit” communication opportunity?

• Surveyed dental patients to ask about ease of communication

Express difficulty to communicate during treat-ment

1 = Very hard to communicate5= Very easy to communicate


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


Prototype Design: Methodology

• Prototype designed with the Axiomatic Design methodology

• Concept: Handheld device with buttons to communicate

Functional Requirements

FR1. Take input data from patients

FR2. Transfer the input data into output data

FR3. Provide output data to dentist and pa-tient


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] http://myworld.ebay.com/protherapysuppliesllc

[2]


Prototype Design: Considerations from the Literature

• Data from mouse, remote control, keyboard was used to de-termine: size, tactual feedback, sensitivity, weight etc.[1]

• Hand data of Koreans, US army, and Jordanians were used when designing the prototype

Right hand dimension data of Jordanian[2] Average length of wrist to fin-ger for US army and Korean[3]

[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


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


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

Type of sound Pain button Stop button Suction buttonEnough (Thank

you) button

Human voice I’m in pain Stop I need suctionThank you(meaning

enough)

Alerting sound Human ouch sound Car klaxon sound Strong wind sound Bell sound

Natural sound Waterfall sound Cuckoo sound


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


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

Not important at all Very important

1 2 4 53

[1] Wilcoxon, F. (1945). Individual comparisons by ranking methods. Biometrics, 1, 80-83


SERVQUAL Survey sheet

Tangible

Reliability

ResponsivenessAssurance

Empathy


Results: SERVQUAL

• Gap score = Perception score - Expectation score

ServiceWith-out

Device

With Device

ServiceWith-out

Device

With Device

Up to date Equipment 0.45 0.32 High-skilled dentist -0.02 -0.15

Clean and neat office 0.4 0.13 Respect -0.01 -0.16

Neat appearance of den-tist

0.57 0.74 Safe treatment -0.24 -0.55

Hygiene Equipment -0.33 -0.38 Honest and trustworthy 0.3 0.22

Precise appointment time -0.25 -0.6 Communicate a lot -0.16 0.05

Service bill demand -0.22 -0.17 Easy access via phone -0.14 -0.4

Accurate treatment record

-0.41 -0.58 Waiting time -0.31 -0.1

Treatment time notice -0.32 -0.32 Convenient location -1.3 -1.45

Willingness to help 0.21 0.06 Record requirements -0.17 -0.39

Quick response from den-tist

0.82 1.17 Recognize customers -0.13 -0.08

Feedback -0.09 -0.07


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

Without Device With Device

Tangible 0.2725 0.2025

Reliability -0.2933 -0.4500

Responsiveness 0.1550 0.210

Assurance 0.0075 -0.1600

Empathy -0.3683 -0.3950

ServiceWithout Device

With Device

Z-valueSignifi-cance

Quick response from den-tist

0.82 1.17 2.9357 O

Communicate a lot -0.16 0.05 2.2505 O

Unweighted SERVQUAL average gap score for each dimen-sion


Results: Overall Questions

Service Without Device With Device

Overall service 4.849 4.788

Communication during treat-ment

4.570 4.671

Kindness of employees 4.767 4.718

Treatment result 4.872 4.835Average score for overall question

Service Z-valueSignifi-cance

Overall service -1.0232 X

Communication during treatment 2.1138 O

Kindness of employees -0.7405 X

Treatment result -0.6765 X


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

28

Thank You.

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

http://xs3d.kaist.edu/


Appendix

30

[Table 8] Hypothesis Testing for all questionnaire


Appendix

[Figure 9] Hypothesis testing

Philwoong Kang – Junhong Kim Hyoyoung Kim – James Morrison Industrial and Systems Engineering...

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