Quality of Dental Care Flashcards
(27 cards)
Define quality
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
What do maxwell’s dimensions of equality take into account?
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
What are the dimensions of quality in healthcare?
Donabedian
Maxwells
Darzi
What are patients views on quality in dental care?
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
Evolution of quality in health care?
Doing things cheaper (efficiency) and doing things better (quality improvement)
= Doing things right and doing the right things (effectiveness) = doing the right things right
Clinical governance?
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
What are the 2 components of clinical governance?
Setting clinical policy
Monitoring clinical policy
Both components must be explicit
What are the benefits of clinical governance?
Improves quality Shared understanding of quality Provides explicit reassurance of quality Greater consumer participation in healthcare - Pt satisfaction - Transparency of service - Strengthened professional regulation
Components of clinical governance: policy settings and monitoring?
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
Policy setting policies?
Evidence based
Clinical guidelines = instructions and principles for specific situations
Clinicians can deviate from guidelines but must say why
NICE, trust policies
What is NICE - policy setting?
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
What must policy setting systems be to improve quality?
Healthcare organisation must demonstrate control, monitoring and evaluation
Systems = simple, cost effective and able to adapt
Policy setting - quality manual?
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
Policy setting - event analysis?
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
Event analysis process?
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 - risk analysis?
Identification, quantification and prevention or minimisation of risk
Important distinction between event analysis and risk analysis
Process of risk management?
- 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?
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
Monitoring - dental contracts?
Benchmarking against activities of other dental practices e.g. no of prescriptions
Adherence to guidelines e.g. NICE
Sometimes termed quality outcomes frameworks
Monitoring - clinical audit?
Systematic critical analysis of the qual of care including:
- Procedures used for diagnosis and tx
- Use of resources
- The resulting outcome
Monitors activity
Criterion based clinical audit?
Comparison of current practice against previously agreed standards and criteria:
- Collect baseline data from case reports, incident occurrences, guidelines, direct observation
- Select a criterion
- Agree standard for performance in this criterion
- Later, review performance against standards
Monitoring - examples of practice audits?
Implementation of delivering better oral health
Implementation of faculty for GDP guidelines on radiography
NICE recall intervals
Monitoring - complaints procedure?
Should have one
Should describe how complaints are handled, when, by whom
Should report on no of complaints
Monitoring - continuing professional development?
Necessary to keep up to date
e.g. courses and lectures, training days, attending conferences, E-learning activity, audits
