Quality Assurance Flashcards
Name the five different views of what makes a good dentist?
Dental view Patient view PCT (NHS commissioning view) Dental Hospital View Staff View
What is the dental view to what makes a good dentist?
Good clinical ability
What is the patient view of what makes a good dentist?
Pain free
seen on time
reasonble cost
What is the PCT view of what makes a good dentist?
Passes inspections
low/no complaints
FUlfil contractual obligations
Few emergencies
What is the dental hospital view of what makes a good dentist?
Appropriate referrals
Good quality referral letters
What is the staff view of what makes a good dentist?
Polite and considerate
Sees patients on time
personal development
Health and Safety
What are the 2 main ways of assessing the quality of healthcare?
Maxwells dimensions of quality
Donabedians Approach to evaluation of a system
What are maxwells 6 dimensions of quality? reference
- Access to services
- Relevance to need
- Social Acceptibilty
- Effectiveness
- Equity
- Efficiency and Economy
Maxwell R 1984
What does access refer to according to maxwell?
Opening hour
location
any obvious barriers to service
can people get treatment when they need it
what does relevance refer to according to maxwell?
Is the balance of services the best that could be achieved when considering needs and wants of the whole population?
What does effectiveness refer to according to maxwell?
Is the treatment given evidence based an the best treatment available
What does the term equity refer according to maxwell?
are patients being fairly treated?
WHat does the term acceptability refer to according to maxwell?
How humanely and considerably is the treatment delivered, are confidentiality safeguarded?
What does the term efficiency refer to according to maxwell?
is the output maximised for the given input
Give an example where maxwells dimnsions of quality can be applied
Cleft lip and palate services in the UK
outcome of unilateral cleft lip and palate at aged 5 1998 showed:
40% poor dental arch relations and untreated caries
19% impossible to understand
Access to services was poor since services were centralised from 57 to 18 centres
What does Donabedian look at?
an approach to evaluation of a system
What three things are important to consider when evaluating an system?
structure: skills of the staff, the buildings and premises, and the equipment the organisation makes available
process: the methods that are adopted by the organisation to provide its services
outcome
What is usually used in Donabedians system instead of outcome and why?
output
because outcome is difficult to measure
Apply Donabedians system to cleft lip and palate?
structure: This considers the buildings, number of staff
Process: number of pateints treated and waiting times
Outcome: appearance, speech
What can be out in place for quality assurance?
A quality framework which is comprised of three stages:
Set standards
Local delivery
Monitoring
What kind of bodies set quality standards?
NICE
CQC
What kind of bodies ensure quality is delivered locally?
Clinical Governance
What kind of bodies and reports monitor quality?
CQC
Dental reference services
Vital signs report
What is clinical governance?
Scally and Donaldson 1998
A framework through which
NHS organisations are accountable for continuously improving the quality of their services
and
safe-guarding the high standards of care
by creating an environment in which excellence in clinical care will flourish
WHat 5 things are done to ensure clinical governance for GDP’s are being carried out?
Clinical audit/peer review CPD Clinical Risk management Complaints procedure Addressing under performanece
How often do clinical audits and peer reviews need to be performed?
15 hours every 3 years
How much CPD need to be done?
75 hours verifiable
175 hours non verifiable
every 5 years
What does clinical risk management consider?
compliance with statutory regulations, staff protection and critical event audit
What features must a complaints procedure have?
an in house system
reasonable time frame
What must be in place for addressing under performance?
whistle blowing policy
Who is responsible for addressing under performance?
all members of the team
According to Lord Darzi 2008 what are the domains of quality?
safety
effectivenss
patient experience
What changes did Lord Darzi’s report on high qualiy care for all have on dental practices?
all practices were as a result are now monitored by CQC where as prevsiously private practices were exepmt
WHat 7 bodies are responsible for quality of dentistry?
PCT GDC Dental services division of BSA CQC National clinical assessment service Colleagues and members of team Yourselves
What is the role of the PCT in ensuring quality?
They monitor contracts and assess performances
WHat is the role of the GDC in ensuring quality?
fitness to practice
CPD
registatrion
private patient complaints
What is the role of the BSA in ensuring quality?
monitor and advise on quality
What is the role of nastional clinical assessment service ensuring quality?
support service, and concerns over the performance of a dentist
What is the role of colleagues and team in ensuring quality?
ensure adhernence to regulation and raise concerns
When was the CQC est?
April 2009
WHat is the role of the CQC?
to act as an independant regulator of health and social care services
What do the CQC perform annually?
health checks looking at
a. Quality of services :using performance indicators and compliance with core standards
b. financial management
What do CQC produce at the end of their health checks?
special reports
What do PCT’s use when assessing quality?
they use performance indicators
What performance indicators are used by PCT’s?
CQC reports referrals to secondary care PALS Critical incidents Whislt blowing CLinical audit random patient questionnaires given by DSD of BSA
What is the purpose of the DSD of BSA?
ensures NHS treatment is necessary and carried out at a satisfactory level
What do the DSD do?
they perform targeted practice inspections at the request of PCT in England but regular inspecions in Wales
What report to DSD produce?
Vital signs report
What us the purpose of vital signs repsort?
set of metrics monitoring key aspects of delivery of primary care dentistry
What are the 7 indicators of quality used in the vital signs report?
percentage of those: re-attending in 3 months urgent treatment free repair/replacement continuations satisfied with treatment recieved satisfied with time to wait for treatment
How can the donabedian approach and maxwells dimensions of care be combined?
They can be combined to form the wright marrix
