Quality Assurance Flashcards
How can you assess the quality of healthcare?
- Maxwell’s dimensions of quality in healthcare
2. Donabedian’s approach to evaluation of a system
How can you assess what makes a good dentist?
General dental council: -standards for the dental team -fitness to practice Nhs commissioning board: -pass practice inspections -low/no complaints -fulfil contractual obligations -few emergencies Dental hospital/colleagues: -appropriate referrals -good quality referral letters Staff view and colleagues: -polite and consideration -see patients on time -personal development -health and safety -patient safety
What are maxwell’s dimensions of quality?
- Access to services (can people get this treatment when they need it? Are there any identifiable barriers to service?)
- Relevance to need (is the overall pattern and balance of services the best that could be achieved taking account needs and wants of the population as a whole?)
- Effectiveness (is the treatment given the best available in a technical sense? What’s their evidence? What’s the result?)
- Equity (does everyone have equal opportunity to gain oral health? Eg. Literacy levels when leaflets sent out, are some people left out because they can’t read them?)
- Social acceptability (how humanely and considerately is this treatment/service being delivered?)
- Efficiency and economy of the system (is the output maximised for a given input? How does the unit cost compare?)
How can maxwells dimensions of quality be applied to cleft?
- Access to services- moved from outreach to central
- Relevance to need-looked not only at the dental needs of the patient but also the psychological needs
- Effectiveness- had to develop their evidence base and make comparisons between sites and look at the geography of where the centres were (that they’re accessible)
- Equity- need to be available and accessible to everyone (geography and ethnic groups)
- Social acceptability- travel, multidisciplinary teams
- Efficient and economy- cost and cost effectiveness
What’s donabedian’s approach to evaluating quality?
Evaluation of a system is based on it’s:
- Structure
- Process
- Outcome (very difficult to measure though so in dentistry ‘output’ is often measured instead which is the volume of work rather than the clinical effectiveness)
How can donabedian’s approach be applied to cleft?
Structure-buildings, staff, staff time (how their time is used)
Process-numbers treated, waiting times
Outcome-appearance, speech, adjustment?
In the quality framework who carries out the different components?
- Who sets the standards? = NICE, care quality commission
- Who makes sure the information is delivered to everyone? = clinical governance
- Who monitors the practices/clinics? = care quality commission board (CQC)
What is clinical governance?
The important aspect of quality assurance. It ensures fair access to effective, prompt, high quality care wherever a patient is treated in the NHS. They propose a new model which marries clinical judgement with clear national standards.
What does clinical governance mean for GDP’s?
- clinical audit/peer review
- continuing professional development
- clinical risk management
- complaints procedure
- addressing under performance
Who is responsible for the quality of dentistry?
- NHS commissioning board
- general dental council
- dental services division of the business services
- care quality commission (CQC) - practice inspections
- national clinical assessment service
- colleagues and members of team
- yourselves
What does the CQC do?
Independent regulator of health and social care. Annual health checks on quality of service (performance indicators, compliance with core standards), financial management.
What are the 7 indicators of quality assessed?
- %re-attendance in 3 months and in 3-9 months
- %urgent treatment
- %free repair/replacement
- % continuations
- % satisfied with treatment received
- %satisfied with time to wait for treatment
How is your performance assessed?
- work context
- your clinical capability (wider than just your performance, also how you work within a team etc)
- behaviour
- health
