Dental Quality Improvement

Getting started in dental quality improvement turns out to be challenging. We have explored some of the problems in previous posts. There have been efforts to develop coherent approaches to QI in dental care, including from the World Dental Federation (FDI). National organisations such as NHS Scotland and Health Education and Improvement Wales are also involved. However, there is enormous scope for further work to better understand the barriers. Solutions still need to be developed.

The DELIVER project is an EU funded programme. It aims to create a toolkit to support the improvement of quality in dental care. The early stages aim to develop an EU dental quality monitoring framework, and to explore existing approaches to dental quality.

Dr Chiu-Yi Lin and colleagues report on a phase of the DELIVER project. It describes views on quality improvement in dental practice in the UK and Germany. The authors chose a combination of purposive and snowball sampling. These are both non-probability sampling methods so they are not designed to obtain a representative sample. As used by the researchers, in this study they allow a range of settings and practitioners to be contacted. This helps the research team to construct a theoretical understanding of how those surveyed think about quality. It also allows them to explore how their situation impacts on this.

The researchers identified two dimensions on which they could locate the views of the participants. These were intention to improve dental quality, and efforts to improve quality. Within these axes, the research team identified six positions. These positions range from a view that quality improvement work detracts from dental care, belonging to managers, to a belief that quality improvement activities require a whole team approach. It is worth looking at the graph and reading the paper to see the range of views encountered.

Respondents reported a tension between private practice and the ability to earn, and the time to spend on quality improvement. There were varying views on whether patients can and should be asked to contribute their views of dental service quality. There was also doubt about what importance authorities place on quality improvement work. Spoiler alert: not much, in the view of some of the respondents.

Some respondents saw quality improvement only in terms of audit. They were unconvinced that audits are any more than a box ticking exercise to satisfy regulators. Other interviewees reported positive changes from audits and other QI work, and believed that the work contributed to service quality.

In Quality Improvement terms, there were references to Standard Work developed from audits. This was heartening to read although this kind of positive experience was clearly far from universal. Successful results from quality improvement activities often lead to further team engagement in quality improvement. Supporting teams to have this kind of experience is important.

The two dimensional structure was not entirely convincing. However, the researchers did a good job in teasing out the importance of setting. They also highlighted the potential impact of the type of role respondents occupied. Perhaps combining setting, role, experience and intention will yield further insights.

As more work from the DELIVER study is reported, the research team will gain a richer understanding of the context of quality improvement. This should help inform dental quality improvement efforts across the world. The current work mostly confirms existing understandings of quality improvement in dental care. It places those understandings in a firmer academic context and develops ways of examining them further. Future outputs from this project should help to illuminate the existing findings, and add new academic insights.

Reference

Lin C, Fehrer V, O’Malley L, et al. Quality Improvement in General Dental Practice: Situational Analysis for the United Kingdom and Germany. JDR Clinical & Translational Research. 2025;0(0). doi:10.1177/23800844241306734

Image by Michal Jarmoluk from Pixabay