Quality of dental services Flashcards
Definition of quality - WHO, 1983 (1)
The nature, kind or character of something. The degree or grade of excellence possessed by . . .
Maxwell’s dimensions of quality in healthcare (6)
Effective Efficient Equitable Acceptable Accessible Appropriate
What are patients views on quality in dental care? (9)
20% pts reported care was 'not good quality' Most important pt factors -access -technical quality of care -professionalism -hygiene/ cleanliness -staff attitude -pain-free tx -value for money -staff putting pts at ease
What is clinical governance? (3)
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 quality assurance transparent and accountable
Two components of clinical governance (2)
Both must be explicit
- setting clinical policy
- monitoring clinical policy
Benefits of clinical governance (4)
Improves quality Shared understanding of quality Provides explicit reassurance of quality Greater consumer participation in health care -pt satisfaction -transparency of service -strengthened professional regulation
Clinical governance: policy setting (6)
Reliance on objective data Systems to facilitate improvement Strategies and targets Legal standards Event analysis Risk management
Clinical governance: monitoring (7)
Care Quality Commission
NHS dental contracts (including benchmarking)
Audit
Complaints
Continuing Professional Development
Self-assessment & Peer review
Other measures of quality including pt satisfaction
Policy setting - reliance on objective data (4)
Evidence-Based
Clinical guidelines = instructions & principles for specific situations
Clinicians can deviate from guidelines but must say why
NICE, Trust policies, other guidelines
Policy setting - NICE (4)
Lead organisation for evidence-based care in NHS
Gives advice on best practice
Produce & disseminate evidence-based guidelines
Clinical and cost-effectiveness
Policy setting - system to improve quality (2)
Healthcare organisation must demonstrate control, monitoring and evaluation
System should be simple, cost-effective and able to adapt
Policy setting - event analysis as an ongoing process (7)
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
Policy setting - event analysis (3)
Usually focuses on negative events e.g. misdiagnosis, prescribing error, clinical complication, breach of confidentiality
Can be used for positive outcomes
Should lead to action plan for improvement to stop event happening again
Policy setting - quality manual - handbook of policies (4)
Each healthcare organisation should have one
Identifies core principles and explicit standards
Evidence based
The standards can be used:
-in training of new staff
-to audit performance
-to demonstrate that all staff are aware of standards
Policy setting - risk analysis (2)
The identification, quantification and prevention or minimisation of risk
Important distinction between event analysis and risk analysis
Process of risk management (4)
- Identify risks
- Assess frequency and severity of risk
- Eliminate risks where possible
- Reduce risk and plan for damage limitation where elimination impossible
Monitoring - care quality commission (4)
Regulates care by all healthcare organisations – including private GDPs
GDPs need to register with the CQC
Two types of reviews:
-regular
-responsive – when concerns standards not met
Bureaucratic but must be done
Monitoring - dental contracts (4)
Benchmarking against activities of other dental practices e.g. number of Units of Dental Activity, prescriptions, courses of treatment etc
Adherence to guidelines e.g. NICE
Recognising and rewarding quality
-proportion of contract contingent on attaining key standards – eg % children receiving fluoride varnish
Sometimes termed Quality Outcomes Frameworks (QoFs)
Monitoring - clinical audit - what is it? (1)
Systematic critical analysis of the quality of care
Monitoring - clinical audit - includes (3)
The procedures used for diagnosis and treatment
The use of resources
The resulting outcome
Monitors activity
Criterion-based clinical audit (5)
The comparison of current practice against previously agreed standards and criteria
1 Collect baseline data from case reviews, incident occurrences, guidelines, direct observation
2 Select a criterion (the topic of the audit)
3 Agree standard for performance in this criterion
4 Later, review performance against standards
Monitoring - complaints procedure (4)
Should have a complaints procedure Should describe how: -complaints are handled -when -by whom Should feed into other aspects of CG -e.g. event analysis Should report on number of complaints
Monitoring - continuing professional development (3)
Necessary to keep up-to-date
Requirement of GDC registration
Enhanced CPD started January 2018
Monitoring - self assessment (1)
Encourages dentists to reflect on own knowledge and ability
Monitoring - peer review (3)
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
Monitoring - pt satisfaction surveys (5)
Focus on patients 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 less relevant dimensions
