Service quality: Why should I care? What’s in it for me?

As a dental nurse operating in the Irish healthcare environment, you will probably by now have come across the term ‘quality’ in some shape or form. You may even have asked yourself what role you have to play in this ‘quality agenda’. Or indeed you might be of the opinion that it is not of importance to you but is the sole concern of the dentist.

Over the coming issues we will hopefully persuade you that quality is everyone’s business and, indeed, is in everyone’s interest. We aim to demonstrate to you that quality need not always lead to more work and greater cost, and put the argument forward that quality is as much a state of mind as it is about processes and expense.

So what is quality and where did the concept come from? The notion of quality has its roots in the era of industrialisation and manufacturing, and the introduction of what has now become known as ‘scientific management’ (Taylor, 1911) and the process approach to work.

The approach became world famous when introduced by Henry Ford in the production of the Model T car, in the early 1900s. The main focus of this initial quality initiative was to streamline activities, identify and eliminate error, and remove waste from production, thus generating a better product for the most economical use of resources. The role of the person, and their contribution to the process, was not considered in these early days of quality.

Fast forward 80 years, and thinking on quality in the 1980s and 1990s was linked with the key works of Deming (1986), Crosby (1979) and, from a healthcare perspective, Berwick (1990) and Ovretveit (1999), all of whom stress the need for:

• Clarity of objective

• A focus on the customer/ patient

• A team approach to service delivery

• Efficient and effective use of resources.

Quality means different things to different people. For us the concept of quality is perhaps best described by Robert M Pirsig (1999) in his book Zen and the art of motorcycle maintenance where he stated, ‘Even though quality cannot be defined, you know what quality is’.

We have presented above three views of quality: the manufacturer’s view whose principal concern was an internal focus and the economical use of resources; the service provider’s view that realised a customer focus should also be considered; then we introduced Pirsig, who challenges that quality is a value that is difficult to attribute words to.

Viewing quality as a value in our healthcare setting brings with it some challenges and expectations. No longer are we just concerned with concepts such as value, promptness, efficiency and process; we also need to consider some other factors:

1. It forces us to look at each patient/service user as an individual to be treated with respect and viewed as a whole person and not just a presenting dental complaint

2. It requires us to ask the patient to express what it is they view as quality. Without knowing this how can we provide it?

3. It also means that each episode of care needs to be viewed as if it were the last. Quality is like that all-important first date – we want to have the right, lasting impression.

So where do you fit in? Quality in dentistry is as much about providing the right professional image (clearly and openly communicating with your patients and fellow team members, and being transparent in all that you do) as it is about following the process in a sequential manner.

While we acknowledge and appreciate the central role played by the dentist in the delivery of care, we must not underestimate the strong communication and human element brought to the patient by the dental nurse and the part you play as a member of the dental team.

In our healthcare environment, particularly in recent years, the Irish Government has made a commitment to ensuring the quality of healthcare service is continually improved and becomes more patient focused (Quality and Fairness: A Health System for You, 2001).

In order to embed such strategies we have seen increasing activities around the new National Oral Health Strategy and, of course, ongoing debates on statutory registration. These initiatives, when achieved, will give the quality agenda in dentistry a stronger voice. It is clear that quality will be on the healthcare agenda for many years to come, so let’s make sure we all proactively play our part.

Over the coming issues we will provide you with some key thoughts and concepts in quality that will better enable you to deliver quality in your healthcare setting.


Berwick DM, Godfrey AB, Roessner J (1990) Curing healthcare: a report on the national demonstration project on quality improvement in healthcare. Jossey-Bass, San Francisco

Crosby P (1979) Quality is free. New York: McGraw-Hill

Deming WE (1986) Out of the crisis. MIT Press

Department of Health and Children (2001) Quality and Fairness: AHealth System for You. publications/quality_and_ fairness.html

Pirsig RM (1999) Zen and the art of motorcycle maintenance: an inquiry into values. New York: Quill. 25th anniversary edition

Ovretveit J (1999) Integrated quality development in public healthcare: a comparison of six hospitals’ quality programmes and a practical theory for quality development. Norway: Norwegian Medical Association

Taylor FW (1911) The principles of scientific management. Harper & Brothers; free book hosted online by Eldritch Press

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