Dental Quality Improvement

Everyone wants to deliver good quality care, so it feels as if it should be straightforward to undertake quality improvement work in dental practices. A report from the Scottish Patient Safety Programme makes it clear, however, that it’s not always easy.

This government funded programme set up an improvement collaborative with dental practices in Scotland. Collaboratives are programmes where groups of clinical teams work on related quality issues at the same time. They share their ideas and learning and are usually supported with quality improvement training. The process is associated with the Institute of Healthcare Improvement in the US. You can read about the work that goes into an improvement collaborative in this handbook if you would like to see the detail.

Like all initiatives, collaboratives are not always successful and it is unclear whether they are more effective than other approaches to quality improvement. Collaboratives need considerable resource and there is limited research evidence on their use in dentistry. Having said that, working across practices to share ideas and experience sounds like a sensible approach, and the Scottish Patient Safety Programme work is a valuable initiative.

As part of their evaluation, staff from some of the participating practices were recruited and interviewed. As well as providing good examples of success, their responses, captured in a peer-reviewed paper, also record the challenges they faced.

The problems they encountered also act as a helpful checklist of what to consider when undertaking QI work in a dental practice:

• Time: Predictably, finding time for the work was a challenge. The work sometimes took longer than that allowed for it and was tricky to fit into practice meetings. One respondent commented that they would have found it easier to find time for it as a Vocational Trainee, than they did as an Associate.
• Patient Engagement: One of the initiatives undertaken by some practices was work on high-risk medications. Problems included patients who were not clear on their medications, or did not share the information, and patients who did not see the value in time spent on the topic.
• Team Engagement and Leadership: When the practice owner was not the lead, or was not actively involved, some respondents reported greater difficulty, including delays in agreeing changes. Keeping teams onboard could also be testing. Some younger dentists reported greater difficulty engaging senior staff, although the flip side of this was that trainees had more time available.
• Communication: This overlapped with engagement. In some practices it was difficult to make sure the whole team was aware of what was happening, which had an impact on understanding. People directly involved in the project were clear on the work, but staff with no immediate involvement took more work to keep up to date. 

This practice-based information is very useful in thinking through the design of practice-based improvement work. Keeping senior staff engaged and informing the wider staff group and gathering their ideas are important issues to consider. Patient engagement is not needed in every QI project, but when it is required, time will be needed to test out the best ways of allowing it to happen. The whole paper has valuable insights into practical QI work in dental practices, and is well worth a look.

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