Dental Quality Improvement

The World Dental Federation (FDI) describes quality in dentistry as ‘ a universal aspiration‘. Their 2017 policy statement calls for continuous quality improvement to be a core component of dental practice, and calls for its inclusion in dental education. The FDI later established the Quality in Dentistry project, which produced a free-to-download dental Quality Improvement Toolkit.

The Toolkit makes an explicit link between the funding and regulatory context of dental practice, and the ability of dental teams to deliver good quality care. These structural aspects of quality and safety are important, and we will discuss them in a later post.

Key recommendations in the toolkit include:

Learning from patients: Feedback from patients can often identify issues of which dental teams are unaware, or which they have not identified as important. Information from surveys, complaints and casual comments can all identify topics that deserve improvement work. Problems can provide information on quality and patient safety problems that would not otherwise be visible.

Team Participation: The people closest to the problem understand the most about it. Imposing solutions on people rarely works. Engaging with staff brings dividends: they work in the system, and are best able to design and test improvements. Often permission to make changes, combined with some Quality Improvement technique, is all that is required to let staff make improvements. As the FDI point out, staff also need to commit to the changes for them to have a realistic opportunity to work. Engagement increases the likelihood of this occurring.

Focus on Processes: Dental practice is usually an individual affair, with at most a dentist and a dental nurse in the room. This leads to a natural tendency to focus on individual practice. This overlooks the processes that get a patient to the dentist, with the right materials, the right skills, and the appropriate equipment, at the right time. The work in the room are processes in their own right, and also need consideration. If individual clinical practice is seen as the only issue, it is difficult to make systematic improvements to patient safety, and to the way a dental team works.

Improvements Should Not be at the Expense of Staff: It is easy to tell people to work harder, to be more careful, to be more efficient, and so on. This loses the point above, that dental teams work within a series of processes. Working harder to try to overcome booking problems and waiting lists often disregards the factors that have produced the problem in the first place. Burnt out, stressed staff are more likely to make mistakes, and turnover will also increase, with costs and problems for the team. On the other hand, process improvements can reduce stress for staff and increase patient safety, producing a win-win for the organisation and their employees.

Apply Quality Improvement Techniques: Knowing where to start with a problem can be difficult. Applying Quality Improvement techniques help in defining a problem, generating solutions, and testing them out. Measurement and the use of methods such as Plan-Do-Study-Act (PDSA) cycles makes a big difference. The methods can be applied within teams, and at large scale. The PDSA approach appeals to the scientific training of a dental team, and gives them hard evidence on the impact of their change.

The FDI Toolkit also offers suggestions for organising Quality Improvement and Patient Safety work in practices, teams and departments, and stresses the role of scientific support by the wider dental academic community.

Our website seeks to provide briefings and links to relevant information, and to support the World Dental Federation’s approach to Quality Improvement in dental care. Their toolkit is a useful resource for dental teams, and worth taking the time to download and consider.

Illustration source: World Dental Federation.