Dental VA Review-Rate Ladder

Use this ladder for one workflow at a time. Do not assign one review rate to the whole person.

Step 1: define the standard.

Write what counts as a material error, the accuracy threshold, the sample size, and the period required before review can decrease. Set a stricter threshold for work involving patient information, money, or sensitive communication.

Step 2: review 100 percent.

Check every item during instruction and early execution. Move down only after the VA completes the routine case correctly across the agreed sample.

Step 3: review a random 50 percent.

Select items throughout the work period. Do not check only the first few items or the easiest cases. Continue until accuracy stays above the threshold and exceptions are handled correctly.

Step 4: review a random 20 percent.

Keep the sample broad enough to include normal variation. If results remain stable, move to occasional spot checks plus exception reporting.

Step 5: review exceptions and outcomes.

The VA reports blocked, unusual, late, or corrected work. The manager reviews the workflow’s operating measures instead of individual items.

When an error occurs.

Find the cause before changing the review rate. Tighten review only for the affected workflow, repair the instruction or procedure where needed, and set the evidence required to move back down the ladder.