Quality of dental services

Question 1

Definition of quality - WHO, 1983 (1)

Answer 1

The nature, kind or character of something. The degree or grade of excellence possessed by . . .

Question 2

Maxwell’s dimensions of quality in healthcare (6)

Answer 2

Effective
Efficient
Equitable
Acceptable
Accessible
Appropriate

Question 3

What are patients views on quality in dental care? (9)

Answer 3

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

Question 4

What is clinical governance? (3)

Answer 4

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

Question 5

Two components of clinical governance (2)

Answer 5

Both must be explicit

• setting clinical policy
• monitoring clinical policy

Question 6

Benefits of clinical governance (4)

Answer 6

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

Question 7

Clinical governance: policy setting (6)

Answer 7

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

Question 8

Clinical governance: monitoring (7)

Answer 8

Care Quality Commission
NHS dental contracts (including benchmarking)
Audit
Complaints
Continuing Professional Development
Self-assessment & Peer review
Other measures of quality including pt satisfaction

Question 9

Policy setting - reliance on objective data (4)

Answer 9

Evidence-Based
Clinical guidelines = instructions & principles for specific situations
Clinicians can deviate from guidelines but must say why
NICE, Trust policies, other guidelines

Question 10

Policy setting - NICE (4)

Answer 10

Lead organisation for evidence-based care in NHS
Gives advice on best practice
Produce & disseminate evidence-based guidelines
Clinical and cost-effectiveness

Question 11

Policy setting - system to improve quality (2)

Answer 11

Healthcare organisation must demonstrate control, monitoring and evaluation
System should be simple, cost-effective and able to adapt

Question 12

Policy setting - event analysis as an ongoing process (7)

Answer 12

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 13

Policy setting - event analysis (3)

Answer 13

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

Question 14

Policy setting - quality manual - handbook of policies (4)

Answer 14

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

Question 15

Policy setting - risk analysis (2)

Answer 15

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

Question 16

Process of risk management (4)

Answer 16

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 17

Monitoring - care quality commission (4)

Answer 17

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

Question 18

Monitoring - dental contracts (4)

Answer 18

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)

Question 19

Monitoring - clinical audit - what is it? (1)

Answer 19

Systematic critical analysis of the quality of care

Question 20

Monitoring - clinical audit - includes (3)

Answer 20

The procedures used for diagnosis and treatment
The use of resources
The resulting outcome
Monitors activity

Question 21

Criterion-based clinical audit (5)

Answer 21

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

Question 22

Monitoring - complaints procedure (4)

Answer 22

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

Question 23

Monitoring - continuing professional development (3)

Answer 23

Necessary to keep up-to-date
Requirement of GDC registration
Enhanced CPD started January 2018

Question 24

Monitoring - self assessment (1)

Answer 24

Encourages dentists to reflect on own knowledge and ability

Question 25

Monitoring - peer review (3)

Answer 25

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 (5)

Answer 26

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