Dental Quality Improvement

‘QA/ CQI and safety will become inseparable parts of dental care’, argues Professor Paul Casamassimo of Ohio State University in a recent paper. The Professor contends that the direction of travel in healthcare is towards an increased focus on quality, quality improvement. and patient safety. Dental teams should think carefully, he recommends, about their own role in the Quality Improvement and Patient Safety movement to avoid being excluded.

The paper, which is open access, is grounded in his work in a hospital dental department, but many of the lessons and arguments are equally applicable in individual and team practice. We have covered some of the same issues, such as equity and barriers to engagement, in previous posts.

Some of the paper’s suggestions, such as involvement in wider hospital Quality and Patient Safety work including morbidity and mortality (M&M) conferences, are more applicable to dental teams working in large healthcare organisations. Others, such as sources of information and learning, and recommendations on how to get started, are useful for any dental team.

These recommendations include:

Learning. Make best use of existing materials. If dentists are embedded in a larger healthcare organisation, they will often find that relevant materials are already available to them. For those working in a smaller dental team, the paper includes suggestions on initial references to review. Our website includes posts signposting free on line resources and local and international courses are available, both in person and on line. One of the owners of this website teaches on an on-line healthcare Quality Improvement course (others are available!). Professor Casamassimo’s message is that learning materials are available and accessible.

Think about team culture and staff engagement. Hierarchical relationships make it difficult to challenge behaviours, and to make suggestions. Teams need to feel safe to identify opportunities for improvement, and to generate ideas for increased quality and safety. Some members of the wider dental team will not be used to being asked for their views, may not feel involved, and may fear being disregarded if they make suggestions. To begin to generate wider involvement, Prof. Casamassimo gives the example of introducing a Time Out (also known as a surgical pause), which involves reception staff, the assisting staff such as a dental nurse, the dentist, and the patient.

Rinse and Repeat. Perseverance, Prof. Casamassimo argues, is essential. Patient Safety improvements, and most Quality Improvement work, involve changes to processes that need to be maintained. They have to become Standard Work – business as usual. When new staff join a team using these processes, some time will need to be set aside to familiarise them with the processes, and the reasons for them.

The message from the paper is that dental teams can and should become involved in Patient Safety and Quality Improvement; that resources to support are available, and most of all, that you can start with small changes that help to familiarise staff with the approach, and can spark enthusiasm.

Reference: Casamassimo, P. S. (2024). Dental Quality Improvement in an Integrated Health Care Setting: Pedal Faster. Journal of the California Dental Association, 52 (1). https://doi.org/10.1080/19424396.2024.2320305

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