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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Does the accreditation of private dental practices work? Time to rethink how accreditation can improve patient safety*

Gillian Jean
+ Author Affiliations
- Author Affiliations

International Research Collaborative – Oral Health and Equity (IRC-OHE), The School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. Email: gillian.jean@uwa.edu.au

Australian Health Review 43(1) 10-14 https://doi.org/10.1071/AH17085
Submitted: 27 March 2017  Accepted: 8 August 2017   Published: 9 October 2017

Abstract

Accreditation to demonstrate engagement with the National Safety and Quality Health Service Standards (Standards) is compulsory for most hospital and healthcare settings, but to date remains voluntary for private dental practices (PDPs). The regulatory framework governing the dental profession lacks a proactive element to drive improvements in quality and safety of care, and an accreditation scheme can strengthen existing regulation. The current model of accreditation operating in accordance with the Australian Health Service Safety and Quality Accreditation Scheme (Scheme) is based on the Standards, which were written for a hospital model of healthcare service. The majority of PDPs are small office-based businesses with clear leadership structure and employing six staff or fewer. The Scheme is overly bureaucratic given the simplicity of the PDP business model. This article considers whether accreditation has a proven track record of improving quality of service and offers opinions about how a more appropriate safety management program for PDPs may look.

What is known about the topic? There has been minimal research about the impact of accreditation schemes in improving patient safety in PDP.

What does this paper add? This paper proposes a redesign of the Scheme to make it more relevant to PDPs. The paper offers strategies to minimise duplication of purpose between accreditation and existing legislation; and to strengthen critical elements of accreditation to improve effects on patient safety.

What are the implications for practitioners? A redesigned accreditation scheme will support dental practitioners to implement a quality assurance system with improved efficiency, reduced administrative burden, and optimised patient safety.

Additional keywords: dental error, National Safety and Quality Health Service Standards, patient protection.


References

[1]  Macleod A, McSherry B. Regulating to ensure patient safety in hospitals: towards a comprehensive framework. J Law Med 2006; 14 228–43.

[2]  Rees J. Hostages of Each Other. Chicago and London: University of Chicago Press; 1994.

[3]  Pinsky HM, Taichman RS, Parment DP. Adaptation of Airline Crew Resource Management Principles to Dentistry. J Am Dent Assoc 2010; 141 1010–18.

[4]  Braithwaite J, Healy J, Dwan K. The governance of health safety and quality. A discussion paper. Canberra: Commonwealth of Australia; 2005.

[5]  Paté-Cornell ME. Risk analysis and risk management for offshore platforms: lessons from the Piper Alpha accident. J Offshore Mech Arct Eng 1993; 115 179–90.
Risk analysis and risk management for offshore platforms: lessons from the Piper Alpha accident.Crossref | GoogleScholarGoogle Scholar |

[6]  Pinsky HM, Taichman RS, Parment DP. Adaptation of airline crew resource management principles to dentistry. J Am Dent Assoc 2010; 141 1010–18.
Adaptation of airline crew resource management principles to dentistry.Crossref | GoogleScholarGoogle Scholar |

[7]  Hudson P. Applying the lessons of high risk industries to health care. Qual Saf Health Care 2003; 12 i7–12.
Applying the lessons of high risk industries to health care.Crossref | GoogleScholarGoogle Scholar |

[8]  Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust 1995; 163 458–71.
| 1:STN:280:DyaK28%2FosV2qsQ%3D%3D&md5=f1ece175b58d32e99fefc909ed2476e6CAS |

[9]  Bristol Royal Infirmary Public Inquiry Team. The report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. Report No. CM5207(I). 2001. Available at: http://webarchive.nationalarchives.gov.uk/20090811143822/http://www.bristol-inquiry.org.uk/final_report/the_report.pdf [verified 22 August 2017]

[10]  Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn L, Corrigan J, Donaldson M, editors. To err is human: building a safer health system. Washington DC: National Academies Press; 2000

[11]  Australian Commission on Safety and Quality in Health Care. Australian health service safety and quality accreditation scheme. Available at: http://www.safetyandquality.gov.au/our-work/accreditation-and-the-nsqhs-standards/australian-health-service-safety-and-quality-accreditation-scheme/#AHSSQA-scheme [verified 16 May 2017].

[12]  Australian Commission on Safety and Quality in Health Care. National safety and quality health service standards. 2012. Available at: http://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf [verified 16 May 2017].

[13]  Ramoni RB. From good to better: towards a patient safety initiative in dentistry. J Am Dent Assoc 2012; 143 956–60.
From good to better: towards a patient safety initiative in dentistry.Crossref | GoogleScholarGoogle Scholar |

[14]  Mills I, Batchelor P. Quality indicators: the rationale behind their use in dentistry. Br Dent J 2011; 211 11–15.
Quality indicators: the rationale behind their use in dentistry.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MnmsV2rtQ%3D%3D&md5=fc50cb9df1e1bf9f4d797e76d11089a2CAS |

[15]  Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. Int J Qual Health Care 2008; 20 172–83.
Health sector accreditation research: a systematic review.Crossref | GoogleScholarGoogle Scholar |

[16]  Braithwaite J, Greenfield D, Westbrook J, Pawsey M, Westbrook M, Gibberd R, Naylor J, Nathan S, Robinson M, Runciman B, Jackson M, Travaglia J, Johnston B, Yen D, McDonald H, Low L, Redman S, Johnson B, Corbett A, Hennessy D, Clark J, Lancaster J. Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study. Qual Saf Health Care 2010; 19 14–21.
Health service accreditation as a predictor of clinical and organisational performance: a blinded, random, stratified study.Crossref | GoogleScholarGoogle Scholar |

[17]  Greenfield D, Braithwaite J. Health Sector Accreditation Research: a Systematic Review. Int J Qual Health Care 2008; 20 172–83.
Health Sector Accreditation Research: a Systematic Review.Crossref | GoogleScholarGoogle Scholar |

[18]  Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, Groene O. The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews. BMC Health Serv Res 2015; 15 277
The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.Crossref | GoogleScholarGoogle Scholar |

[19]  Kaplan HC, Provost LP, Froehle CM, Margolis PA. The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf 2012; 21 13–20.
The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement.Crossref | GoogleScholarGoogle Scholar |

[20]  Thomlinson S., Australian Dental Practice Survey 2015, News Bulletin August 2015. St Leonards, NSW: Australian Dental Association; 2015.

[21]  Barraclough B. Lessons from the inquiry into obstetrics and gynaecological services at King Edward Memorial Hospital 1990–2000. Australian Council for Safety and Quality in Health Care; 2002. Available at: https://safetyandquality.gov.au/wp-content/uploads/2012/01/king_edward.pdf [verified 22 August 2017].

[22]  Australian Commission on Safety and Quality in Health Care (ACSQHC). NSQHS standards guide for dental practices and services. Sydney: ACSQHC; 2015.

[23]  Australian Dental Association. Proceeding with practice accreditation. St Leonards, NSW: Australian Dental Association; 2016.

[24]  Woolcott Research. Consumer research regarding safety and quality in health care. Prepared for the Australian Commission for Safety and Quality in Health Care. 2014. Available at: http://www.safetyandquality.gov.au/wp-content/uploads/2014/12/Consumer-Research-regarding-Safety-and-Quality.pdf [verified 10 January 2016].

[25]  Australian Commission on Safety and Quality in Health Care (ACSQHC). National safety and quality health service standards version 2: consultation draft. Report No. Trim: D15-26010. Sydney: ACSQHC; 2015. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2016/07/DRAFT-National-Safety-and-Quality-Health-Service-Standards-version-21.pdf [verified 22 August 2017].

[26]  IKAS. DDKM (Danish Quality Model), Accreditation Standards for Dental Practices. 2015; last edited 14 June 2017. Available at: http://www.ikas.dk/deltagere-i-ddkm/privatpraktiserende-tandlæger/ddkm-for-privatpraktiserende-tandlæger/ [verified 22 August 2017]. [In Danish].

[27]  Care Quality Commission. How CQC Regulates Primary Dental Services: Provider Handbook. 2015. Available at: http://www.cqc.org.uk/sites/default/files/20150611_dental_care_provider_handbook.pdf [verified 22 August 2017].

[28]  RACGP, Australian Commission on Safety and Quality in Health Care. General practice accreditation to benefit from collaborative approach. Media Release, 11 April 2014. Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2014/04/Joint-communique-General-practice-accreditation-to-benefit-from-collaborative-approach.pdf [verified 22 August 2017].

[29]  Dental Board of Australia. Continuing professional development (CPD) resources. 2015. Available at: http://www.dentalboard.gov.au/Codes Guidelines/CPD.aspx [verified 16 May 2017].

[30]  The National Law as applies in each State or Territory; Health Practitioner Regulation National Law Act 2010 (ACT); Health Practitioner Regulation National Law (NSW); Health Practitioner Regulation (National Uniform Legislation) Act (NT); Health Practitioner Regulation National Law (South Australia) Act 2010 (SA); Health Practitioner National Law (Tasmania) Act 2010 (Tas); Health Practitioner Regulation National Law (Victoria) Act 2009 (Vic); Health Practitioner Regulation National Law (WA) Act 2010 (WA).

[31]  Pemberton MN. Developing patient safety in dentistry. Br Dent J 2014; 217 335–7.
Developing patient safety in dentistry.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2M7psFKgsA%3D%3D&md5=104476521f5f4bbf5bf1d93a29e788f0CAS |

[32]  Gawande A. The checklist. The New Yorker 10 December 2007. Available at: http://www.newyorker.com/magazine/2007/12/10/the-checklist [verified 10 August 2017].

[33]  Levine R, William M. Esthetic risk assessment in implant dentistry. Inside Dentistry 2012; 8 66–71.

[34]  Yamalik N, Van Dijk W. Analysis of the attitudes and needs/demands of dental practitioners in the field of patient safety and risk management. Int Dent J 2013; 63 291–7.
Analysis of the attitudes and needs/demands of dental practitioners in the field of patient safety and risk management.Crossref | GoogleScholarGoogle Scholar |