Marginal gains in dentistry?

Readers who have had contacts with big business will be aware of the concept of Six Sigma. This was invented at Motorola in 1986 and adopted by many companies, most famously by Jack Welsh at General Electric. The concept aims to eliminate error in the manufacturing process. For example, in a complex manufacturing process, such as in an aircraft engine, only one part needs to be defective for the whole engine not to work. Unwanted variation spells disaster, so statistical methodologies are used to eliminate this. A company that has achieved Six Sigma has a 99.997% success rate, which means 3.4 errors per million opportunities to make a mistake.¹

Matthew Syed's book Black Box Thinking² should be prescribed reading for all dental students and practising clinicians, as it addresses, among other topics, ‘The Logic of Failure’, ‘The Blame Game’ and ‘Cognitive Dissonance’. However, it was the section on ‘Marginal Gains’ that caught my eye. In this, Matthew describes a Six Sigma-like aim for improvement in the Team Sky professional cycling team. Their manager developed an approach whereby, if one breaks a big goal into small parts, and then improves on each of these (even if minimally), then this would facilitate a massive increase when all are put together.