November 1, 2013
By David Vergun
WASHINGTON (Army News Service, Nov. 1, 2013) -- For the past several decades, only about 20 percent of Soldiers were classified as "class 1 dental wellness." In the dental community, that means those Soldiers were up to date on cleanings and required no dental work, said the commander of U.S. Army Dental Command.
That number has since risen to around 40 percent and is climbing, said Col. Thomas R. Tempel Jr. The success is due to the "Go First Class" program.
Tempel explained that the program was tested, and then instituted at various dental treatment facilities during the last 18 months. On Oct. 1, all 131 facilities Army-wide were using the program.
The concept of Go First Class is remarkably elegant, Tempel said.
Traditionally, Soldiers would go for a routine exam, he explained. After the exam, they'd get another appointment for a cleaning and another for other work such as getting a filling.
That approach entailed a lot of appointments and time spent in the waiting room, he said. It also played havoc with unit training schedules.
The back and forth to appointments was so bad that only about half of the Soldiers who were told to return for dental work ever did so.
"We were not taking care of our Soldiers," he said.
Lt. Gen. Patricia Horoho, the Army's surgeon general, and Maj. Gen. M. Ted Wong, chief, U.S. Army Dental Corps, asked the Army Dental Command team how dental readiness could be improved, he said.
"We came up with a proactive approach," he said, "whereby Soldiers who come in for an exam also get a cleaning and often get a cavity filled all in one visit."
The approach seems like a no-brainer, but it took about a year to fully implement, he said. The scheduling system needed to be reworked and the dentists ended up with a higher case load, since more Soldiers were getting work done.
Although the dentists are really busy now with no new hires, he said, their morale is high because they realize that they are directly contributing to the wellness and readiness of the force, through healthier Soldiers and more training time for commanders.
Soldiers too are happier.
In at least the past few decades, Soldiers have had a positive opinion of Army dentistry, he said, with satisfaction levels hovering at around 92 percent in surveys. Tempel thought that the upper limit had been reached since it's hard to satisfy all of the people all of the time. But a new survey breached that mark, and customer satisfaction is now up to 95 percent and might continue climbing.
The Army chief of staff and the sergeant major of the Army were especially delighted by the savings in cost and training time when they were briefed in March, he said. The program saves about 1.25 million hours of time per year, equating to $31 million in E-4 pay and benefits, he said.
The time and cost factors were computed by estimating the time spent in the waiting room.
The cost and time savings associated with the program already could improve even more in the future, he said, because the one-stop preventative care received will result in fewer larger problems down the road -- cavities, root canals and so on, he said.
"Soldiers who achieve Class 1 are five times less likely to experience a dental emergency than someone who is Class 3," and needs work done, he said. "That's good for readiness, especially units deployed."
BLUE OCEAN THINKING
"The Army surgeon general's vision is to 'improve the health of the nation by improving the health of the Army,'" Tempel said. She and the Dental Corps commander "allowed our team to think freely and provide them with ideas," a term Horoho coined "blue ocean thinking," meaning broad and in-depth.
Also as a result of this thinking, a new business model was adopted.
Although Dental Command makes up only about four percent of the entire Army Medical Command, it now runs on the Operating Company Model, which complex businesses use to process and organize procedures for more efficiency, he said.
That model was also used to standardize dental care across the Army, he added. There are plans to increase efficiency even more in the coming year, with an automated system in the works that will track Soldiers who are deemed high risk.
"High risk" within the dental community includes those patients with a history of dental problems, poor oral hygiene, and habits such as smoking that are detrimental to good oral health.
The model will also be used to improve data quality and dental record audits.
Although Soldiers still carry their dental record portfolio with them when they change duty stations, Tempel said he's hopeful that before he retires he'll see implementation of a paperless system for all records.
Tempel's "dream list" also includes seeing the rollout of a vaccine or maybe special gum that's chewed which prevents cavities. It seems farfetched, but he said Army researchers are working on those today.
Those Army researchers have already had some big successes.
They came out with a digital reader that's portable -- about the size of a suitcase -- that functions like an X-ray machine out in the field. It's being used today in remote areas of Afghanistan, he said.
Other Army research is being conducted on trauma, he noted, like facial and tooth reconstruction following an event like an improvised explosive device blast.
These are exciting times to be an Army dentist, Tempel concluded.
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