Dental Quality Improvement

Dentists don’t get much undergraduate training in Quality Improvement and Patient Safety approaches, if any. Every team runs into problems that would benefit from a Quality Improvement approach, but where do you start?

At its core, Quality Improvement is straightforward: you identify a problem, analyse it, and work with your team to improve the situation. There are any number of bells and whistles that can be added depending on the situation and its complexity, but if you keep in mind this – problem – team – analysis – improvement – concept, you will always have a good place to start.

This post, and more in the series to follow, describe ideas and techniques you can use in getting started on a problem. Other posts have linked to on-line materials that you can use to find more details, but you don’t need a qualification in improvement science to get started and to produce meaningful change.

Sometimes an area for improvement work jumps out at you: there is a never event or a patient safety problem, a complaint, or a near miss. In other instances, there is a recurrent problem that gets in the way of the team’s work, and acts as a constant irritant. For example, there is a problem with a booking system, uneven workloads, days of the week that always get behind, problems with a payment system, a recurring machinery problem, etc.

Checking the team’s understanding of the issue is the best place to start. If you impose your own view, you lose the opportunity to hear from others, and to engage people from the start. Questions to consider include:

• What is the nature of the problem? This is a description, rather than an immediate attempt to understand the cause. Once people agree on what is happening, you can begin to tease out possible contributing factors, but agreeing what is happening, rather than what may be causing it, is a good place to start.
• How often does it happen? Some problems feel important but happen rarely. This may mean the issue is still worth tackling, but understanding its frequency helps both to understand it, and to begin to appreciate it’s impact.
• How severe is the impact of the problem? Is this a minor irritation that happens frequently, a severe problem that happens uncommonly, or some other combination of severity and impact? A rare problem that causes catastrophic problems, such as law suits, may be uncommon but need addressed at once. On the other hand, a less severe problem that causes a drip, drip, drip of annoyance and confusion may be just as important to the practice.

If several problems present themselves, you can prioritise them. A common method is to use a prioritisation matrix. This sounds complicated, but it is straightforward in practice. You and your team decide on two dimensions that you want to tease out, such as the impact an improvement would have it you were successful, and how difficult you estimate it will be to achieve (|Figure 1).

Figure 1: A Prioritisation Matrix

If you draw the dimensions out on a piece of paper, you have four boxes: lower impact and more difficult to achieve; lower impact and easier to achieve; higher impact and difficult to achieve, and higher impact and easier to achieve. Estimating where problems lie on this spectrum gives you a structure to decide what you want to tackle first.

Check out part two of this series for suggestions on how to understand the problem you and your team decide to tackle first.

Photo by Ivan Samkov at pexels.com