Quality of Dental Care

Question 1

Define quality

Answer 1

Nature, kind or character of something
Features of characteristics of a product that bear on its ability to satisfy a stated or implied need
Fitness for purpose

Question 2

What do maxwell’s dimensions of equality take into account?

Answer 2

The population as well as pt care
Dimensions include:
- Access
- Appropriateness to need
- Effectiveness - on an individual pt basis
- Equality - could the service be made more fair?
- Acceptability - too uncomfortable/embarrassing/painful to undertake procedure so avoid tx?
- Efficiency

Question 3

What are the dimensions of quality in healthcare?

Answer 3

Donabedian
Maxwells
Darzi

Question 4

What are patients views on quality in dental care?

Answer 4

20% of 500 pts reported that their care was not good quality
- Most important pt factors:
Access
Technical qual of care
Professionalism
Hygiene
Staff attitude
Pain free tx
Value for money
Staff putting pts at ease

Question 5

Evolution of quality in health care?

Answer 5

Doing things cheaper (efficiency) and doing things better (quality improvement)
= Doing things right and doing the right things (effectiveness) = doing the right things right

Question 6

Clinical governance?

Answer 6

Those actions and systems put in place to monitor and enhance the quality of clinical services

• Joins all quality assurance activity into single framework
• Makes QA both transparent and accountable

Question 7

What are the 2 components of clinical governance?

Answer 7

Setting clinical policy
Monitoring clinical policy
Both components must be explicit

Question 8

What are the benefits of clinical governance?

Answer 8

Improves quality
Shared understanding of quality
Provides explicit reassurance of quality
Greater consumer participation in healthcare
- Pt satisfaction 
- Transparency of service
- Strengthened professional regulation

Question 9

Components of clinical governance: policy settings and monitoring?

Answer 9

Policy setting

• Reliance on objective date
• Systems to facilitate improvement
• Strategies and targets
• Legal standards
• Event analysis
• Risk management

Monitoring

• Care quality comission
• NHS dental contracts
• Audit
• Complaints
• Continuing professional development
• Self assessment and peer review
• Pt satisfaction

Question 10

Policy setting policies?

Answer 10

Evidence based
Clinical guidelines = instructions and principles for specific situations
Clinicians can deviate from guidelines but must say why
NICE, trust policies

Question 11

What is NICE - policy setting?

Answer 11

National institute for heath and care excellence

• Lead organisation for evidence based care in NHS
• Gives advice on best practice
• Produce and disseminate evidence based guidelines
• Clinical and cost effective

Question 12

What must policy setting systems be to improve quality?

Answer 12

Healthcare organisation must demonstrate control, monitoring and evaluation
Systems = simple, cost effective and able to adapt

Question 13

Policy setting - quality manual?

Answer 13

Each healthcare organisation needs one
Identifies core principles and explicit standards
Evidence based
Standards can be used:
- In training of new staff
- To audit performance
- To demonstrate that all staff are aware of standards

Question 14

Policy setting - event analysis?

Answer 14

Focuses on negative events - misdiagnosis, never event
Can be used for positive outcomes
Should lead to action plan for improvement to stop event happening again

Question 15

Event analysis process?

Answer 15

1 Describe event
2 List effects of event
3 Deduce why outcome happened
4 Consider how outcome could have been different
5 Review and Revise procedures re. Recurrence
6 Agree and implement change
7 Audit change

Question 16

Policy setting - risk analysis?

Answer 16

Identification, quantification and prevention or minimisation of risk
Important distinction between event analysis and risk analysis

Question 17

Process of risk management?

Answer 17

1. Identify risks
2. Assess frequency and severity of risk
3. Eliminate risks where possible
4. Reduce risk and plan for damage limitation where elimination impossible

Question 18

Monitoring - care quality commission?

Answer 18

Regulates care by all healthcare organisations - including private GDPs
GDPs need to register with CQC
2 types of reviews
- Regular
- Responsive - when concerns standards not met

Question 19

Monitoring - dental contracts?

Answer 19

Benchmarking against activities of other dental practices e.g. no of prescriptions
Adherence to guidelines e.g. NICE
Sometimes termed quality outcomes frameworks

Question 20

Monitoring - clinical audit?

Answer 20

Systematic critical analysis of the qual of care including:

• Procedures used for diagnosis and tx
• Use of resources
• The resulting outcome

Monitors activity

Question 21

Criterion based clinical audit?

Answer 21

Comparison of current practice against previously agreed standards and criteria:

1. Collect baseline data from case reports, incident occurrences, guidelines, direct observation
2. Select a criterion
3. Agree standard for performance in this criterion
4. Later, review performance against standards

Question 22

Monitoring - examples of practice audits?

Answer 22

Implementation of delivering better oral health
Implementation of faculty for GDP guidelines on radiography
NICE recall intervals

Question 23

Monitoring - complaints procedure?

Answer 23

Should have one
Should describe how complaints are handled, when, by whom
Should report on no of complaints

Question 24

Monitoring - continuing professional development?

Answer 24

Necessary to keep up to date

e.g. courses and lectures, training days, attending conferences, E-learning activity, audits

Question 25

Monitoring - self assessment and peer review?

Answer 25

Self assessment - encourages dentists to reflect on own knowledge and ability

Peer review:

• Groups of dentists meet to share experiences and identify changes that could lead to improvement
• Usually consists of 4-8 dentists from 2+ practices
• Can be useful to identify CPD needs

Question 26

Monitoring - pt satisfaction surveys?

Answer 26

Focus on pts perception of quality
Satisfaction is a multi-dimensional concept
Focus on clinical or non-clinical aspects
Should focus on: things important to pt, things you can change
Off the shelf measures - save time, have reference values, may use relevant dimensions

Question 27

Monitoring - satisfaction surveys?

Answer 27

Family and friends tests - would you recommend our practice to friends or family if they need similar care/tx