Acting on quality

In our June 2008 article we introduced you to the basic concept of quality and the different perspectives it requires you to have on your business. Taking the view of the patient, the other members of the dental team, the supplier or other stakeholders brings with it many views of what quality is. We also suggested that quality does not always have to have a cost attached. This month we provide you with some examples that can set you on the road to continuous quality improvement, without spending a single cent.

In this article we share with you how some everyday items available in your practice can be used in quality improvement. We also provide you with an analysis tool that is effective in all settings.

At its core, quality improvement is based on the concept of the continuous improvement cycle. Working in healthcare quality management for over five years we have found that a useful framework to guide quality improvement initiatives is the PDCA cycle.

Originally devised by Deming (1986), this simple yet effective tool is grounded in four key actions, taken in sequence. These actions form the ‘Plan – Do – Check – Act’ (PDCA) cycle.

There are many situations in which the PDCA can be applied in a dental setting, resulting in quality improvements, giving benefit to patients and staff, and leading to more efficient means of working and cost savings.

Quality in practice
Within each of the four stages there are tools and techniques that can be used to help you progress. In fact you may already have many tools in operation but simply do not use them to their full potential. The following suggestions will help you to identify potential opportunities that you could use to help improve quality management in your surgery.

Tools for planning
• Appointment systems – for planning: weekly schedules, materials, special equipment and requirements, staffing, etc
• Budgets – ensuring: appropriate costing of treatments, the practice is operating within realistic financial limits
• Holiday plans/leave requests – ensuring the matching of availability of staff with clinical needs
• Treatment plans – planning the patient session and identifying: equipment, materials, dental laboratory work and other needs
• Best practice guidelines and standards – helping the clinic to operate according to best practice and ensuring efficient and safe patent care.

Tools for doing
• Patient records – tracking all patient activities, both clinical and administrative
• Surgery layout – ensuring the surgery operates efficiently and effectively by considering layout and work flow
• Patient leaflets – reinforcing education and information given to the patient
• Product usage guidelines and material safety data sheets – ensuring materials and products are used in accordance with the manufacturers’ intent
• Policies, procedures and guidelines – helping the clinic to operate according to best practice and ensuring efficient and safe patent care.

Tools for checking
• Checklists – streamlining daily, weekly and monthly checks that need to be carried out, e.g. sterilisation, hand hygiene, infection control, stock rotation, dates, reminder appointments, toilet checks, etc
• Reports – for example, invoicing, statements, banking
• Audit – ensuring policies and procedures are being adhered to and identify areas for improvement
• Patient feedback and questionnaires – gaining insight into the patient’s experience.

Tools for acting
This is perhaps one area where you may not have experience in using quality improvement tools. We therefore take this opportunity to work through a model that can be used to explore and identify action plans for improvements.
This model is the 5 Ws & H:
• Five Ws & H – when faced with an issue, the 5Ws and H is a useful tool for analysing what the problem is by simply asking ‘Who? What? When? Where? Why?’ and using ‘How?’ to explore possible solutions. 
This tool draws on Kipling’s (1902) poem accompanying The Elephant’s Child, which opens with:
A worked example, based upon Figure 2 above, for the problem of arranging cover while on leave could include:
1. Who needs to know?
2. What exactly do they need to know?
3. When are you proposing to go on leave?
4. Where is the appointment diary located, where are the computer passwords for patient accounts kept, etc?
5. Why is it important that you communicate you are going on leave and to whom?
6. How will your replacement be able to work more efficiently? Will you have a change over period? Do you have work instructions to leave behind?
We have touched on the role of technology as a tool for ‘planning’ and ‘doing’, and audit as a method for ‘checking’. We will explore these in more detail next time when we look at benchmarking, audit and the role of technologies in facilitating quality improvements.
In closing, we encourage you to look with a quality eye at the many resources you have at your disposal. Consider how these resources can be better utilised and help you on your quality journey.

* References are available upon request.

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