Changing policy with continuous improvement tools

Published February 24, 2020

Dianne Notaro poses next to the UB School of Dental Medicine seal.

Dianne Notaro 


As a patient advocate at the University at Buffalo’s School of Dental Medicine, Dianne Notaro has spent the last 13 years giving patients a voice and ensuring they receive the best care. 

“If I see a potential problem, I’ll do whatever I can to first identify the cause of the problem, and then try to resolve it,” says Notaro, whose compass is patient phone calls and letters, as well as staff feedback.

She is enhancing her quality improvement skill set with the aid of UB’s Center for Industrial Effectiveness (TCIE) professional education. Expanding her repertoire is paying off: by leveraging course learnings, she is influencing policy changes. 

Notaro has enrolled in various TCIE business improvement courses since 2014, feeding her lifelong affinity for combatting poor quality. Now she is a student of the Certified Lean Professional (CLP) program as she aspires to improve UB Dental operations. The teaching facility is an avenue for UB School of Dental Medicine students to apply their education with faculty oversight. Community members receive care in exchange, at costs lower than those charged by the private sector.

In particular, Notaro aims to streamline the patient screening process – the steps from when a prospective patient calls until he or she arrives for a screening. Her goal is to create better procedures with Lean’s waste-reducing approach, and subsequently reinforce the school’s service standards.

Notaro’s first dabble in a structured problem-solving method began with the Root Cause Analysis and Corrective Action (RCA) class.

It was excellent. I probably learned more from that course, in one day, than I have from taking whole semester-long courses in college,” she says. “The two most important  things I learned were to challenge the data and forgo assumptions.”

RCA attendees come to class with one actual problem to use as a case study. Notaro  questioned the higher-than-desired rate of patient discharge in the middle of crown treatments. Too frequently, delinquency on final payments halted the process. The result? Too many people left with temporary crowns.   

The “5 Why” technique exposed the reality that patients do not always grasp billing statements and the installment plan. The math was also confusing to students and, at times, even the business office.   

“We petitioned administration to lower the cost of a crown and get payment up front. Then we can eliminate a lot of this waste,” Notaro says.

Lobbying efforts led to policy changes in 2017. Additionally, this semester marks the debut of a clinical patient management grade. It assesses students on how they discuss monetary obligations with patients, manage appointments, and guarantee that service proceeds smoothly. 

Notaro has not scrupulously tracked outcomes of the change, but she says the number of unfinished treatments has decreased substantially. That’s a win for not only the patient, but the student who needs to complete requirements to graduate.  

RCA was the start of Notaro’s journey in structured continuous improvement practices. Other TCIE courses have led to:

  • Greater confidence in assisting the compliance staff when auditing bodies visit, by completing Certified Quality Auditor (CQA) Preparation training and later earning CQA certification
  • Deciding on Lean as her chosen path after taking Yellow Belt training
  • Retaining, organizing and acting on problems or ideas that arise from meetings, thanks to tools introduced at the Value Stream Mapping course

The knowledge gained, Notaro concedes, is empowering. It supports her role on the school’s quality improvement committee. She feels emboldened in her pursuit of boosting accountability at the UB School of Dental Medicine.

The business methodologies provide tested and proven procedures that “help me to have a stronger voice in my own career, where I try not to be insulated. I want to be challenged professionally.”

Professional goals aside, Notaro sees the impact that continuous improvement can make in her field. She likens it to the World Health Organization’s “best buys” – cost-effective measures that prevent and control noncommunicable diseases.

“I think by using these quality improvement tools and Lean process manufacturing management principles, we [UB School of Dental Medicine] can be a ‘best buy’.”